Provider Demographics
NPI:1083716229
Name:FRANCISCAN HEALTH SYSTEM
Entity Type:Organization
Organization Name:FRANCISCAN HEALTH SYSTEM
Other - Org Name:FRANCISCAN PHARMACY ST CLARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-428-8560
Mailing Address - Street 1:11315 BRIDGEPORT WAY SW STE A1087
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3004
Mailing Address - Country:US
Mailing Address - Phone:253-985-6290
Mailing Address - Fax:253-985-6295
Practice Address - Street 1:11315 BRIDGEPORT WAY SW STE A1087
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3004
Practice Address - Country:US
Practice Address - Phone:253-985-6290
Practice Address - Fax:253-985-6295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHI FRANCISCAN HEALTH ST CLARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-01
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACR00005230333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0103541OtherL&I
WA6015861Medicaid