Provider Demographics
NPI: | 1497124580 |
---|---|
Name: | ST FRANCIS MEDICAL CENTER |
Entity Type: | Organization |
Organization Name: | ST FRANCIS MEDICAL CENTER |
Other - Org Name: | SFMC MEDICAL CLINICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP FINANCE/ CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KELLY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 609-599-5036 |
Mailing Address - Street 1: | 500 GROVE ST |
Mailing Address - Street 2: | SUITE 100 |
Mailing Address - City: | HADDON HEIGHTS |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08035-1761 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-796-9200 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 601 HAMILTON AVE |
Practice Address - Street 2: | |
Practice Address - City: | TRENTON |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08629-1915 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-599-5000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ST FRANCIS MEDICAL CENTER |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2015-09-18 |
Last Update Date: | 2015-09-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty |