Basic Information
| Provider Information | |||||||||
| NPI: | 1417138348 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. FRANCIS ENT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7546 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319087546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063247753 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 MANCHESTER EXPY | ||||||||
| Address2: | STE C003 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319046877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063247753 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2007 | ||||||||
| LastUpdateDate: | 04/27/2015 | ||||||||
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| AuthorizedOfficialLastName: | HEMBREE | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO/SVP | ||||||||
| AuthorizedOfficialTelephone: | 7063203751 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. FRANCIS HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 114080 | 05 | AL | MEDICAID | 075886718A | 05 | GA | MEDICAID |