Provider Demographics
NPI:1578070363
Name:FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM INC
Other - Org Name:RXONE ST FRANCIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP, CMO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:GREMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-765-8724
Mailing Address - Street 1:309 JACKSON ST
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7407
Mailing Address - Country:US
Mailing Address - Phone:318-966-7242
Mailing Address - Fax:318-966-7224
Practice Address - Street 1:309 JACKSON ST
Practice Address - Street 2:FLOOR 1
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7407
Practice Address - Country:US
Practice Address - Phone:318-966-7242
Practice Address - Fax:318-966-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY.007573-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175202OtherPK
LA2205871Medicaid