Provider Demographics
NPI:1225251937
Name:FRANCISCAN HEALTH SYSTEM
Entity Type:Organization
Organization Name:FRANCISCAN HEALTH SYSTEM
Other - Org Name:WOUND, OSTOMY & CONTINENCE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, FINANCIAL OPS
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 1:1717 S J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4933
Mailing Address - Country:US
Mailing Address - Phone:253-426-6893
Mailing Address - Fax:253-426-6449
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:253-426-6893
Practice Address - Fax:253-426-6449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-11
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005284261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0206370OtherSTATE L&I
WA7131642Medicaid
WA7131642Medicaid
WAG8858812Medicare PIN