Provider Demographics
NPI: | 1467693135 |
---|---|
Name: | ST. FRANCIS MEDICAL GROUP, LLC |
Entity Type: | Organization |
Organization Name: | ST. FRANCIS MEDICAL GROUP, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRACTICE OPERATIONS EXECUTIVE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ANDERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 317-528-4943 |
Mailing Address - Street 1: | PO BOX 771846 |
Mailing Address - Street 2: | |
Mailing Address - City: | DETROIT |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48278-1846 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-885-2870 |
Mailing Address - Fax: | 317-885-2971 |
Practice Address - Street 1: | 701 E COUNTY LINE RD STE 101 |
Practice Address - Street 2: | |
Practice Address - City: | GREENWOOD |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46143-1070 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-885-2860 |
Practice Address - Fax: | 317-885-2869 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-03-10 |
Last Update Date: | 2022-09-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 50000962A | 207Q00000X, 207QG0300X, 207R00000X, 207RC0200X, 207RH0002X, 207RP1001X, 207RR0500X, 207RS0012X, 207V00000X, 208000000X, 208M00000X, 363LA2100X, 363LA2200X, 363LF0000X |
207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QG0300X | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | Group - Multi-Specialty |
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
No | 207RH0002X | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |