Provider Demographics
NPI:1184650889
Name:FRANCISCAN ST. FRANCIS HEALTH
Entity Type:Organization
Organization Name:FRANCISCAN ST. FRANCIS HEALTH
Other - Org Name:ST. FRANCIS NEIGHBORHOOD HEALTH CENTER AT GARFIELD PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, ABO, FRANCISCAN ALLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-528-4800
Mailing Address - Street 1:1040 SIERRA DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:234 EAST SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-2121
Practice Address - Country:US
Practice Address - Phone:317-781-9669
Practice Address - Fax:317-781-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200119050AMedicaid
IN192810Medicare ID - Type Unspecified