Provider Demographics
NPI:1477542744
Name:ST FRANCIS MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:ST FRANCIS MEDICAL CENTER, INC
Other - Org Name:ST FRANCIS HEALTH & WELLNESS CLINIC
Other - Org Type:Doing Business As
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:318-327-7165
Mailing Address - Fax:318-327-7162
Practice Address - Street 1:408 HALL ST
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7529
Practice Address - Country:US
Practice Address - Phone:318-327-7165
Practice Address - Fax:318-327-7162
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-19
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA157-H261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444499Medicaid
LA1444499Medicaid