NPI |
1104911965 |
The date that a record was last updated or changed. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Organization Name Legal Business Name |
SAINT FRANCIS MEDICAL CENTER |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Other Organization Name |
HEALING ARTS & SPECIALTY PHARMACY |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
3250 GORDONVILLE RD STE 101 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
CAPE GIRARDEAU |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MO |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
637035092 |
|
Provider Business Practice Location Address Country Code If outside U S |
US |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Provider Business Practice Location Address Telephone Number |
5733390999 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Provider Business Practice Location Address Fax Number |
5733345993 |
|
Provider Enumeration Date |
10/4/2006 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Last Update Date |
7/6/2022 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
GILLILAND |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
KIMBERLY |
The first name of the authorized official. |
Authorized Official Middle Name |
D |
The middle name of the authorized official. |
Authorized Official Title or Position |
CREDENTIALING |
The title or position of the authorized official. |
Authorized Official Telephone Number |
5733315583 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
3336C0003X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Other Provider Identifier 1 |
609679501 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 1 |
05 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 1 |
MO |
|
Is Organization Subpart |
N |
|
NPI Certification Date |
7/6/2022 |
|