Basic Information
| Provider Information | |||||||||
| NPI: | 1932206455 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST FRANCIS HOSPITAL | ||||||||
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| OtherOrganizationName: | ST. FRANCIS PROFESSIONAL SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 SW ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616021320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096552850 | ||||||||
| FaxNumber: | 3096554878 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 LUDINGTON ST | ||||||||
| Address2: | |||||||||
| City: | ESCANABA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498291300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067863311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2006 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCGREW | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OSF HEALTHCARE SYSTEM | ||||||||
| AuthorizedOfficialTelephone: | 3096552850 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 23006 | 01 | MI | COMMUNITY CHOICE MI | OTHER | XX25063 | 01 | MI | HEALTHPLUS OF MI | OTHER | 134080905 | 01 | MI | US DEPT OF LABOR | OTHER | 0B16009 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 12264 | 01 | MI | PRIORITY HEALTH | OTHER | 025940 | 01 | MI | MIDWEST HEALTH PLAN | OTHER | CE9198 | 01 | MI | RAILROAD MEDICARE | OTHER |