MEDICARE: ST FRANCIS PHYSICIAN PRACTICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Y00000X	Otolaryngology Physician
2	2086S0129X	Vascular Surgery Physician
3	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1679948012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST FRANCIS PHYSICIAN PRACTICES LLC

Provider Business Mailing Address
First Line	:	3726 WOODRUFF RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5601
Country	:	US
Telephone Number	:	706-257-7680
Fax Number	:	706-257-7681

Provider Business Practice Location Address
First Line	:	3726 WOODRUFF RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5601
Country	:	US
Telephone Number	:	706-257-7680
Fax Number	:	706-257-7681

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESS JUDY
Credential	:
Telephone Number	:	615-920-7000

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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