Provider Demographics
NPI:1710903539
Name:ST FRANCIS COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:ST FRANCIS COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-792-7425
Mailing Address - Street 1:7464 N CLARK
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626
Mailing Address - Country:US
Mailing Address - Phone:847-316-2500
Mailing Address - Fax:847-316-2006
Practice Address - Street 1:7464 N CLARK
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626
Practice Address - Country:US
Practice Address - Phone:847-316-2500
Practice Address - Fax:847-316-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL544000Medicare ID - Type Unspecified