Provider Demographics
NPI:1568767606
Name:ST FRANCIS PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:ST FRANCIS PHYSICIAN SERVICES INC
Other - Org Name:FOOTHILLS ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT NETWORK OPERATIONS
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:864-605-3755
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:864-234-7815
Mailing Address - Fax:864-234-7846
Practice Address - Street 1:10 ENTERPRISE BLVD
Practice Address - Street 2:STE. 201
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6301
Practice Address - Country:US
Practice Address - Phone:864-234-7815
Practice Address - Fax:864-234-7846
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS PHYSICIAN SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-21
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8157Medicare PIN