Provider Demographics
NPI:1780632463
Name:IHC-ST. FRANCIS EMERGENCY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:IHC-ST. FRANCIS EMERGENCY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIERLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-290-6700
Mailing Address - Street 1:111 E WISCONSIN AVE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4815
Mailing Address - Country:US
Mailing Address - Phone:414-290-6720
Mailing Address - Fax:414-290-6755
Practice Address - Street 1:355 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3328
Practice Address - Country:US
Practice Address - Phone:414-290-6720
Practice Address - Fax:414-290-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125363000OtherOWCP
IL01622045OtherILLINOIS BCBS
ILCN6395OtherMEDICARE RAILROAD
IL020446200OtherFEDERAL BLK LUNG PROGRAM
FL913949400Medicaid
IL=========OtherTRICARE NORTH REGION
ILCN6395OtherMEDICARE RAILROAD
IL436940Medicare ID - Type Unspecified