Provider Demographics
NPI:1689689069
Name:SAINT FRANCIS MEDICAL GROUP
Entity Type:Organization
Organization Name:SAINT FRANCIS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:KHOURI
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-771-4366
Mailing Address - Street 1:909 HYDE ST STE 125
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4832
Mailing Address - Country:US
Mailing Address - Phone:415-771-4366
Mailing Address - Fax:415-771-6412
Practice Address - Street 1:909 HYDE ST STE 125
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4832
Practice Address - Country:US
Practice Address - Phone:415-771-4366
Practice Address - Fax:415-771-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB93636FOtherMEDICAL CLIA
CAGR0076920Medicaid
CA05D0593636OtherCLIA#
CALAB93636FOtherMEDICAL CLIA