1720403595 NPI number — ST FRANCIS COLUMBUS CLINIC LLC

Table of content: (NPI 1720403595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720403595 NPI number — ST FRANCIS COLUMBUS CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST FRANCIS COLUMBUS CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST FRANCIS COLUMBUS CLINIC SPECIALTY BUILDING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720403595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31908-9247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-243-4404
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 17TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31901-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-243-4404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
706-596-4160

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  POD000814 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com