Provider Demographics
NPI:1932892601
Name:FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM INC
Other - Org Name:RXONE ST DOMINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP, CMO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:GREMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-765-8724
Mailing Address - Street 1:971 LAKELAND DR STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4607
Mailing Address - Country:US
Mailing Address - Phone:601-200-4980
Mailing Address - Fax:601-200-4989
Practice Address - Street 1:971 LAKELAND DR STE 101
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4607
Practice Address - Country:US
Practice Address - Phone:601-200-4980
Practice Address - Fax:601-200-4989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MISSIONARIES OF OUR LADY HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-30
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy