Provider Demographics
NPI:1447605514
Name:ST. FRANCIS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. FRANCIS REGIONAL MEDICAL CENTER
Other - Org Name:ST. FRANCIS URGENT CARE - SOUTHBRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JERDEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-428-2400
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MAIL ROUTE 10860
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-1166
Mailing Address - Fax:
Practice Address - Street 1:8170 OLD CARRIAGE CT STE 100
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3164
Practice Address - Country:US
Practice Address - Phone:952-428-3600
Practice Address - Fax:952-428-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC09338Medicare PIN