1871865923 NPI number — ROPER SAINT FRANCIS PHYSICIANS NETWORK

Table of content: (NPI 1871865923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871865923 NPI number — ROPER SAINT FRANCIS PHYSICIANS NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROPER SAINT FRANCIS PHYSICIANS NETWORK
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:
Provider Other Organization Name Type Code:
6
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:
1871865923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 603379
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-3379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-258-9186
Provider Business Mailing Address Fax Number:
843-269-2186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
912 INLET SQUARE DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MURRELLS INLET
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-651-4111
Provider Business Practice Location Address Fax Number:
843-651-1047
Provider Enumeration Date:
02/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVERIO
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/CEO RSFPP
Authorized Official Telephone Number:
843-789-1665

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: L00339 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191 . This is a "TRICARE SUFFIX" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 169 . This is a "BCBS SC AND BLUECHOICE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: DP0704 . This is a "RR MEDICARE PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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