Basic Information
| Provider Information | |||||||||
| NPI: | 1407256415 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT FRANCIS MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 ASYLUM AVE | ||||||||
| Address2: | SUITE 2103 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607145058 | ||||||||
| FaxNumber: | 8607148311 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 ASYLUM AVE | ||||||||
| Address2: | SUITE 2120 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602464000 | ||||||||
| FaxNumber: | 8605276985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2014 | ||||||||
| LastUpdateDate: | 08/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | ELLNER | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | DO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8607145237 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.