Provider Demographics
NPI:1306824990
Name:ST FRANCIS MEDICAL CENTER
Entity Type:Organization
Organization Name:ST FRANCIS MEDICAL CENTER
Other - Org Name:KNEIBERT CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-778-7774
Mailing Address - Street 1:225 PHYSICIANS PARK STE 100
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3918
Mailing Address - Country:US
Mailing Address - Phone:573-778-7774
Mailing Address - Fax:573-778-7230
Practice Address - Street 1:225 PHYSICIANS PARK STE 100
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3918
Practice Address - Country:US
Practice Address - Phone:573-778-7774
Practice Address - Fax:573-778-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157579OtherPK
MO600295406Medicaid
MO0328140004Medicare NSC