Provider Demographics
NPI:1205531894
Name:ST. FRANCIS CLINIC
Entity type:Organization
Organization Name:ST. FRANCIS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:ASUQUO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-290-7125
Mailing Address - Street 1:PO BOX 12351
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-0351
Mailing Address - Country:US
Mailing Address - Phone:304-290-7125
Mailing Address - Fax:
Practice Address - Street 1:1241 E ERIE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-5525
Practice Address - Country:US
Practice Address - Phone:304-290-7125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service