Provider Demographics
NPI:1518285691
Name:ST. FRANCIS PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:ST. FRANCIS PHYSICIAN SERVICES INC
Other - Org Name:MILLENNIUM INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE-BSMG
Authorized Official - Prefix:
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:864-605-3762
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-365-0123
Mailing Address - Fax:864-365-0133
Practice Address - Street 1:2 INNOVATION DR STE 300A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5268
Practice Address - Country:US
Practice Address - Phone:864-365-0123
Practice Address - Fax:864-365-0133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. FRANCIS PHYSICIAN SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-13
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8157Medicare PIN