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	208200000X	Plastic Surgery Physician
2	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1982432035
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	:	888-472-0043
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	125 DOUGHTY ST STE 125
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-5782
Country	:	US
Telephone Number	:	843-402-1766
Fax Number	:	843-402-1768

Authorized Official
Title or Position	:	VP
Name	:	ROBERT OLIVERIO
Credential	:
Telephone Number	:	843-266-4400

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	08/26/2024

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