Healthcare Provider Details

I. General information

NPI: 1104374131
Provider Name (Legal Business Name): ROPER SAINT FRANCIS PHYSICIANS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 11/27/2023
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 N MAIN ST SUITE C
SUMMERVILLE SC
29483
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-606-7020
  • Fax: 843-606-7019
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: ROBERT R. OLIVERIO JR.
Title or Position: VP/CEO RSFPP
Credential: MD
Phone: 843-724-2903