Provider Demographics
NPI:1275857773
Name:ST. FRANCIS OBSTETRIC & GYNECOLOGY, LLC
Entity Type:Organization
Organization Name:ST. FRANCIS OBSTETRIC & GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/SVP
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-596-4020
Mailing Address - Street 1:PO BOX 9027
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9027
Mailing Address - Country:US
Mailing Address - Phone:706-320-1069
Mailing Address - Fax:
Practice Address - Street 1:959 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1984
Practice Address - Country:US
Practice Address - Phone:706-324-1069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. FRANCIS OBSTETRIC & GYNECOLOGY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA82510207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty