Provider Demographics
NPI: | 1376654749 |
---|---|
Name: | ST FRANCIS PHYSICIAN CLINICS ON OPERATING DIV OF ST FRAN HEA CTR |
Entity Type: | Organization |
Organization Name: | ST FRANCIS PHYSICIAN CLINICS ON OPERATING DIV OF ST FRAN HEA CTR |
Other - Org Name: | ST FRANCIS PHYSICIAN CLINICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ESSENCE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MONTGOMERY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 785-270-7636 |
Mailing Address - Street 1: | 500 ELDORADO BLVD |
Mailing Address - Street 2: | STE 6250 |
Mailing Address - City: | BROOMFIELD |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80021-3422 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 855-851-4127 |
Mailing Address - Fax: | 303-272-0390 |
Practice Address - Street 1: | 1700 SW 7TH ST |
Practice Address - Street 2: | |
Practice Address - City: | TOPEKA |
Practice Address - State: | KS |
Practice Address - Zip Code: | 66606-1674 |
Practice Address - Country: | US |
Practice Address - Phone: | 785-295-8108 |
Practice Address - Fax: | 785-231-5991 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-08-31 |
Last Update Date: | 2017-01-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207Q00000X, 207V00000X, 207VX0000X, 208D00000X, 208M00000X, 363AM0700X, 363L00000X, 367A00000X | ||
KS | 207R00000X, 207RC0000X, 207RE0101X, 207RH0003X, 208G00000X, 208VP0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207VX0000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | Group - Multi-Specialty |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KS | 100458160A | Medicaid | |
KS | 110935 | Medicare Oscar/Certification |