Provider Demographics
NPI:1205860483
Name:ST. FRANCIS PRIMARY CARE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ST. FRANCIS PRIMARY CARE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EMERSON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUCKHALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-491-9281
Mailing Address - Street 1:1045 ATLANTIC AVE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3408
Mailing Address - Country:US
Mailing Address - Phone:562-491-9281
Mailing Address - Fax:
Practice Address - Street 1:3628 E IMPERIAL HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2643
Practice Address - Country:US
Practice Address - Phone:310-631-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty