Provider Demographics
NPI:1811289283
Name:SAINT FRANCIS MEDICAL CENTER
Entity type:Organization
Organization Name:SAINT FRANCIS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-331-5583
Mailing Address - Street 1:211 SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5049
Mailing Address - Country:US
Mailing Address - Phone:573-331-5228
Mailing Address - Fax:573-331-5016
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703
Practice Address - Country:US
Practice Address - Phone:573-331-5228
Practice Address - Fax:573-331-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006008758174400000X
MO2002005133174400000X
MOR5H64174400000X
MO102167174400000X
MO2006015230174400000X
MOR8D70174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01440833OtherKENTUCKY CAID
MO01060802Medicaid
MO63703004OtherTRICARE PROVIDER #
MO001OtherILLINOIS CAID INSTITUTION
MO153OtherANTHEM BLUECROSS BLUESHIELD
MO46165OtherGHP
MO110375OtherHEALTHLINK
MO3623OtherHEALTH ALLIANCE
MO46165OtherGHP