Provider Demographics
NPI:1386118917
Name:SAINT FRANCIS MEDICAL CENTER
Entity type:Organization
Organization Name:SAINT FRANCIS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:G
Authorized Official - Last Name:WITTENBORN
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:573-331-3080
Mailing Address - Street 1:225 PHYSICIANS PARK STE 301
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3930
Mailing Address - Country:US
Mailing Address - Phone:573-686-2220
Mailing Address - Fax:573-686-5642
Practice Address - Street 1:225 PHYSICIANS PARK STE 301
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3930
Practice Address - Country:US
Practice Address - Phone:573-686-2220
Practice Address - Fax:573-686-5642
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT FRANCIS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty