MEDICARE: ROPER SAINT FRANCIS PHYSICIANS NETWORK

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	213E00000X	Podiatrist		SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DP0704	OTHER	SC	RAILROAD MEDICARE GROUP ID-RSFPN

General Provider Information

NPI Number	:	1720376130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROPER SAINT FRANCIS PHYSICIANS NETWORK

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	2075 EAGLE LANDING BLVD
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-4074
Country	:	US
Telephone Number	:	843-881-9158
Fax Number	:	843-971-1105

Authorized Official
Title or Position	:	VP RSFPP
Name	:	MR. DOUGLAS BOWLING
Credential	:
Telephone Number	:	843-724-2910

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	07/20/2011

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