# ASCENSION SACRED HEART GULF

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SHMGG Port St. Joe Ortho
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366113284
- **Authorized official:** MIRANDA HEMM (ENROLLMENT MANAGER)
- **Authorized official phone:** (850) 229-5792

## Contact information

- **Practice address:** 3871 E HIGHWAY 98 STE 202, PORT ST JOE, FL 32456-5302
- **Practice address phone:** (850) 229-5792
- **Practice address fax:** (850) 229-5789
- **Mailing address:** 4205 BELFORT RD STE 4015, JACKSONVILLE, FL 32216-3623

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/21/2021
- **Last updated:** 09/21/2021