Provider Demographics
NPI:1417138348
Name:ST. FRANCIS ENT, LLC
Entity Type:Organization
Organization Name:ST. FRANCIS ENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/SVP
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEMBREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-320-3751
Mailing Address - Street 1:PO BOX 7546
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7546
Mailing Address - Country:US
Mailing Address - Phone:706-324-7753
Mailing Address - Fax:
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE C003
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6877
Practice Address - Country:US
Practice Address - Phone:706-324-7753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. FRANCIS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-20
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL114080Medicaid
GA075886718AMedicaid
GA075886718AMedicaid