Provider Demographics
NPI:1932154846
Name:ST FRANCIS MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:ST FRANCIS MEDICAL CENTER, INC
Other - Org Name:SFMC CARDIAC SURGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VP OF FINANCE SFMC
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-327-7369
Mailing Address - Street 1:312 GRAMMONT STREET
Mailing Address - Street 2:STE 401
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7385
Mailing Address - Country:US
Mailing Address - Phone:318-361-0085
Mailing Address - Fax:318-325-3501
Practice Address - Street 1:312 GRAMMONT STREET
Practice Address - Street 2:SUITE 401
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7385
Practice Address - Country:US
Practice Address - Phone:318-361-0085
Practice Address - Fax:318-325-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1948501Medicaid
LA5C318Medicare ID - Type Unspecified