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General NPI Number Information
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NPI Number | 1831366467
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Entity Type | Organization
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Legal Business Name | ST FRANCIS MEDICAL GROUP MOORESVILLE
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 1201 HADLEY RD
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City | MOORESVILLE
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State | IN
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Zip | 46158-1737
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-1479
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Provider Business Mailing Address
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Address Line | PO BOX 781076
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City | DETROIT
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State | MI
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Zip | 48278-1076
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-1479
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Authorized Official
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Title or Position | AMBULATORY BUSINESS OFFICE DIRECTOR
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Name | BRAD JOUBERT
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Credential |
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Telephone | 317-528-4291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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