Basic Information
| Provider Information | |||||||||
| NPI: | 1285727727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FASIPE | ||||||||
| FirstName: | FRANCISCA | ||||||||
| MiddleName: | REMILEKUN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TAIWO | ||||||||
| OtherFirstName: | FRANCISCA | ||||||||
| OtherMiddleName: | REMILEKUN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 505164 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631505164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178294620 | ||||||||
| FaxNumber: | 4178294316 | ||||||||
| Practice Location | |||||||||
| Address1: | 1235 E CHEROKEE ST | ||||||||
| Address2: | ST JUDE - MERCY AFFILIATE CLINIC | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658042203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178205833 | ||||||||
| FaxNumber: | 4178208018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 10/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | MA076548 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | 2080P0207X | 2009015951 | MO | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | 178701001 | 05 | AR | MEDICAID | 0023051 | 05 | NJ | MEDICAID | 209373505 | 01 | MO | HEALTHNET LEGACY | OTHER | 3416925 | 01 | NJ | AETNA | OTHER | P3165305 | 01 | NJ | OXFORD | OTHER | 010005845 | 01 | NJ | AMERICHOICE | OTHER | 1285727727 | 05 | MO | MEDICAID | 2521640 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER | 3K5979 | 01 | NJ | HEALTHNET | OTHER | 7778481 | 01 | NJ | CIGNA | OTHER | 1635912 | 01 | NJ | AMERIHEALTH PPO/PA BS | OTHER | 2310999000 | 01 | NJ | AMERIHEALTH/KEYSTONE/IBC | OTHER | 60004100 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 431560263 | 01 | TRICARE WEST | OTHER |