Provider Demographics
NPI:1477700805
Name:ST FRANCIS PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:ST FRANCIS PHYSICIAN SERVICES INC
Other - Org Name:HILLCREST FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRES-NETWORK OP
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-605-3721
Mailing Address - Street 1:PO BOX 25039
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0039
Mailing Address - Country:US
Mailing Address - Phone:864-963-1548
Mailing Address - Fax:864-963-3381
Practice Address - Street 1:717 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681
Practice Address - Country:US
Practice Address - Phone:864-963-1548
Practice Address - Fax:864-963-3381
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS PHYSICIAN SERVCIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-27
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207Q00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1382Medicaid
SCGP1382Medicaid
8157Medicare PIN