MEDICARE: ST FRANCIS AFFILIATED SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	367H00000X	Anesthesiologist Assistant
2	363A00000X	Physician Assistant
3	367500000X	Certified Registered Nurse Anesthetist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GRP3756	OTHER	GA	MEDICARE GROUP #

General Provider Information

NPI Number	:	1528039047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST FRANCIS AFFILIATED SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 235019
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36123-5019
Country	:	US
Telephone Number	:	334-279-1450
Fax Number	:	334-279-1660

Provider Business Practice Location Address
First Line	:	2122 MANCHESTER EXPY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-6878
Country	:	US
Telephone Number	:	706-320-3077
Fax Number	:	706-596-4293

Authorized Official
Title or Position	:	CFO
Name	:	MATT MOORE
Credential	:
Telephone Number	:	706-320-3077

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	10/31/2007

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