# ASCENSION SACRED HEART GULF

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ascension Sacred Heart Gulf
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083941678
- **Authorized official:** COBA SUSAN CORNEJO (COO)
- **Authorized official phone:** (850) 416-6206

## Contact information

- **Practice address:** 3801 E HIGHWAY 98, PORT ST JOE, FL 32456-5318
- **Practice address phone:** (850) 229-5600
- **Practice address fax:** (850) 416-7453
- **Mailing address:** 7928 SOLUTION CTR, LOCKBOX 777928, CHICAGO, IL 60677-7009
- **Mailing address phone:** (850) 416-7190
- **Mailing address fax:** (850) 416-7453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 275N00000X | Medicare Defined Swing Bed Hospital Unit | — | FL | — |
| 282NR1301X | Rural Acute Care Hospital | — | FL | Yes |

## Other

- **Enumeration date:** 11/03/2009
- **Last updated:** 03/05/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 002012700 | — | FL |
| 01 | — | 159 | BLUE CROSS OF FL | FL |