Provider Demographics
NPI:1760690101
Name:SAINT FRANCIS CARE MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:SAINT FRANCIS CARE MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SURENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-714-4361
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 4309
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-1325
Mailing Address - Fax:
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:SAINT FRANCIS CARE MEDICAL GROUP PC
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-979-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT FRANCIS CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CT207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004211215Medicaid
CT8413924000Medicaid
CT004156437Medicaid
CT008025819Medicaid
CT004211215Medicaid