Healthcare Provider Details

I. General information

NPI: 1013162494
Provider Name (Legal Business Name): ST FRANCIS PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 S POINSETT HWY
TRAVELERS REST SC
29690-1822
US

IV. Provider business mailing address

PO BOX 743294
ATLANTA GA
30374-3294
US

V. Phone/Fax

Practice location:
  • Phone: 864-834-7834
  • Fax: 864-834-7477
Mailing address:
  • Phone: 864-834-7834
  • Fax: 864-834-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: WILBUR R GAY III
Title or Position: CFO
Credential:
Phone: 864-605-3762