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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

General Provider Information

NPI Number	:	1467000166
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	:	3510 N HIGHWAY 17 STE 220
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-8245
Country	:	US
Telephone Number	:	843-720-8317
Fax Number	:	843-720-8319

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT OLIVERIO
Credential	:
Telephone Number	:	843-789-9319

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	11/27/2023

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