Basic Information
Provider Information
NPI: 1962501957
EntityType: 2
ReplacementNPI:  
OrganizationName: ST FRANCIS HOSPITAL AND MEDICAL CENTER INC
LastName:  
FirstName:  
MiddleName:  
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Credential:  
OtherOrganizationName: ST FRANCIS HOSPITAL CRNA GROUP
OtherOrganizationType: 3
OtherLastName:  
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Mailing Information
Address1: 400 E 10TH ST
Address2:  
City: WACONIA
State: MN
PostalCode: 553874552
CountryCode: US
TelephoneNumber: 9524429770
FaxNumber: 9524423630
Practice Location
Address1: 1700 SW 7TH ST
Address2:  
City: TOPEKA
State: KS
PostalCode: 666061674
CountryCode: US
TelephoneNumber: 7852958111
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/22/2006
LastUpdateDate: 05/14/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KONGS
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR OF FINANCIAL SERVICES
AuthorizedOfficialTelephone: 7852958111
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X  Y193400000X SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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