MEDICARE: ST FRANCIS PHYSICIAN SERVICES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RB0002X	Obesity Medicine (Internal Medicine) Physician		SC
2	208600000X	Surgery Physician		SC

General Provider Information

NPI Number	:	1588959316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST FRANCIS PHYSICIAN SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 743294
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3294
Country	:	US
Telephone Number	:	864-675-4815
Fax Number	:	864-675-4780

Provider Business Practice Location Address
First Line	:	135 COMMONWEALTH DR STE 210
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4850
Country	:	US
Telephone Number	:	864-675-4815
Fax Number	:	864-675-4780

Authorized Official
Title or Position	:	CFO
Name	:	WILBUR R GAY III
Credential	:
Telephone Number	:	864-605-3762

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	07/02/2019

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Directions to “ST FRANCIS PHYSICIAN SERVICES INC ” Practice Location

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