Provider Demographics
NPI:1437149168
Name:ST FRANCIS MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:ST FRANCIS MEDICAL CENTER, INC
Other - Org Name:EKG SERVICES & HOSPITAL BASED PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO/SR VP
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-327-7369
Mailing Address - Street 1:PO BOX 1901
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-1901
Mailing Address - Country:US
Mailing Address - Phone:318-327-4255
Mailing Address - Fax:318-327-4764
Practice Address - Street 1:309 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7407
Practice Address - Country:US
Practice Address - Phone:318-327-4255
Practice Address - Fax:318-327-4764
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-25
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1572080N0001X, 2085R0202X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1796069Medicaid
LA1796069Medicaid