Basic Information
| Provider Information | |||||||||
| NPI: | 1154854388 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAINT FRANCIS MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | SAINT FRANCIS CLINIC JACKSON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 801143 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641801143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733315583 | ||||||||
| FaxNumber: | 5733315079 | ||||||||
| Practice Location | |||||||||
| Address1: | 2130 E JACKSON BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637552907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732433115 | ||||||||
| FaxNumber: | 5732434700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2017 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | DAVISON | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5733313000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.