Provider Demographics
NPI:1427374198
Name:ST JOSHEPH MEDICAL CENTER
Entity Type:Organization
Organization Name:ST JOSHEPH MEDICAL CENTER
Other - Org Name:FRANCISCAN HEALTH SYSTEMS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILCZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-426-6989
Mailing Address - Street 1:PO BOX 31001-1440
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-1440
Mailing Address - Country:US
Mailing Address - Phone:253-396-6790
Mailing Address - Fax:253-396-6730
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:253-396-6790
Practice Address - Fax:253-396-6730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH INITIATIVES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-20
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-032282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9044884Medicaid