Provider Demographics
NPI:1114633864
Name:ROPER SAINT FRANCIS PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:ROPER SAINT FRANCIS PHYSICIANS NETWORK
Other - Org Name:ROPER ST. FRANCIS PHYSICIAN PARTNERS GYNECOLOGY ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CMO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:OLIVERIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-266-4400
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:888-472-0043
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:1879 SAVAGE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4726
Practice Address - Country:US
Practice Address - Phone:843-402-1301
Practice Address - Fax:843-402-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPG1352Medicaid