Sacred Heart Medical Group
Otolaryngology in Miramar Beach, FL. Organization (NPI-2).
NPI number1053083394
StatusActive
Last updated in NPPESOct 5, 2021
Details
- NPI
- 1053083394
- Entity type
- Organization (NPI-2)
- Legal business name
- Sacred Heart Medical Group
- Organization subpart
- No
- Enumeration date
- Oct 5, 2021
- Certification date
- Oct 5, 2021
- Last updated
- Oct 5, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Y00000X | Otolaryngology | – | – | Yes |
Other names
- Shmg Ent At Destin (Other Name)
Practice location
7720 Us Highway 98 W Ste 370Miramar Beach, FL 32550-7232
Phone 850-622-5148 · Fax 850-622-5149
Mailing address
4205 Belfort Rd Ste 4015Jacksonville, FL 32216-3623
Authorized official
Jean Vallier
Director-Managed Care
8506225148
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