Basic Information
| Provider Information | |||||||||
| NPI: | 1093075582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT FRANCIS MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | CHARLESTON FAMILY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 801143 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641843225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132628160 | ||||||||
| FaxNumber: | 8138919066 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638341644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736833739 | ||||||||
| FaxNumber: | 5736834956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2012 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | BALSANO | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 5733313000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.