Provider Demographics
NPI:1649414285
Name:ROPER SAINT FRANCIS PHYSICIANS NETWORK
Entity Type:Organization
Organization Name:ROPER SAINT FRANCIS PHYSICIANS NETWORK
Other - Org Name:ROPER ST FRANCIS PHYSICIAN PARTNERS LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CEO RSFPP
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLIVERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-724-2903
Mailing Address - Street 1:PO BOX 603379
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3379
Mailing Address - Country:US
Mailing Address - Phone:888-258-9186
Mailing Address - Fax:843-269-2186
Practice Address - Street 1:4450 LEEDS PLACE WEST
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:843-763-2611
Practice Address - Fax:843-852-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42D0250660291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC065OtherTRICARE SUFFIX
SC068OtherBCBSSC SUFFIX
SC086OtherBLUECHOICE SUFFIX
SCL00271Medicaid
SC614387326OtherDEPT OF LABOR - FECA/ENERGY/BLACK LUNG
SCDP0704OtherRAILROAD MEDICARE GROUP PTAN
SC9923Medicare PIN