Basic Information
| Provider Information | |||||||||
| NPI: | 1598109852 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. FRANCIS CARDIOVASCULAR INSTITUTE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9086 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319089086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065964170 | ||||||||
| FaxNumber: | 7063228483 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 MANCHESTER EXPY | ||||||||
| Address2: | STE 1007 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319046877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065964170 | ||||||||
| FaxNumber: | 7063228483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2013 | ||||||||
| LastUpdateDate: | 04/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | HEMBREE | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO/SVP | ||||||||
| AuthorizedOfficialTelephone: | 7063203751 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 003140969A | 05 | GA | MEDICAID | 153003 | 05 | AL | MEDICAID |