Provider Demographics
NPI:1871865923
Name:ROPER SAINT FRANCIS PHYSICIANS NETWORK
Entity type:Organization
Organization Name:ROPER SAINT FRANCIS PHYSICIANS NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/CEO RSFPP
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-789-1665
Mailing Address - Street 1:PO BOX 603379
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3379
Mailing Address - Country:US
Mailing Address - Phone:888-258-9186
Mailing Address - Fax:843-269-2186
Practice Address - Street 1:912 INLET SQUARE DR
Practice Address - Street 2:SUITE B
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-651-4111
Practice Address - Fax:843-651-1047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL00339Medicaid
SC191OtherTRICARE SUFFIX
SC169OtherBCBS SC AND BLUECHOICE
SCDP0704OtherRR MEDICARE PTAN
SCL00339Medicaid