Provider Demographics
NPI:1770589178
Name:ST FRANCIS PHYSICIAN SERVICES INC
Entity type:Organization
Organization Name:ST FRANCIS PHYSICIAN SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:864-605-3721
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-286-9050
Mailing Address - Fax:864-286-6885
Practice Address - Street 1:304 ASHBY PARK LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6903
Practice Address - Country:US
Practice Address - Phone:864-286-9050
Practice Address - Fax:864-286-6885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS PHYSICIAN SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-22
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8157207Q00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2943Medicaid
8157Medicare PIN
SC6905Medicare ID - Type Unspecified