Provider Demographics
NPI:1255663696
Name:ST. FRANCIS MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:ST. FRANCIS MEDICAL GROUP, LLC
Other - Org Name:ST. FRANCIS MEDICAL GROUP ONCOLOGY HEMATOLOGY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE OPERATIONS EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-893-1870
Mailing Address - Street 1:9002 N MERIDIAN ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5381
Mailing Address - Country:US
Mailing Address - Phone:317-927-5770
Mailing Address - Fax:317-927-5792
Practice Address - Street 1:9002 N MERIDIAN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5381
Practice Address - Country:US
Practice Address - Phone:317-927-5770
Practice Address - Fax:317-927-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6376670001Medicare NSC