Provider Demographics
NPI:1225224223
Name:FRANCISCAN HEALTH SYSTEM
Entity Type:Organization
Organization Name:FRANCISCAN HEALTH SYSTEM
Other - Org Name:FRANCISCAN PSYCHOLOGY-NEUROPSYCHOLOGY SERVICES @ ST JOSEPH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCIAL OPERATIONS
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:253-552-4105
Mailing Address - Street 1:1812 S J ST
Mailing Address - Street 2:STE 220
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4964
Mailing Address - Country:US
Mailing Address - Phone:253-426-6762
Mailing Address - Fax:253-426-6224
Practice Address - Street 1:1812 S J ST
Practice Address - Street 2:STE 220
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4964
Practice Address - Country:US
Practice Address - Phone:253-426-6762
Practice Address - Fax:253-426-6224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-24
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0224795OtherSTATE L&I
WA7139231Medicaid
WA8907052OtherSTATE CRIME VICTIMS
WA8854508Medicare PIN
WA8907052OtherSTATE CRIME VICTIMS