=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861019143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROPER SAINT FRANCIS PHYSICIANS NETWORK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2020
-----------------------------------------------------
Last Update Date | 03/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3510 HIGHWAY 17 N STE 105
-----------------------------------------------------
City | MT. PLEASANT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29466-8228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-789-1850
-----------------------------------------------------
Fax | 843-724-2551
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 751649
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28275-1649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-472-0043
-----------------------------------------------------
Fax | 843-724-2440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP CMO
-----------------------------------------------------
Name | ROBERT R. OLIVERIO JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 843-724-2903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207XS0114X
-----------------------------------------------------
Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------