Provider Demographics
NPI:1437397361
Name:FRANCISCAN MEDICAL GROUP
Entity Type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:FMG-CARLOS E. MORAVEK, MD (GH)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-680-4009
Mailing Address - Street 1:1624 S. I ST.
Mailing Address - Street 2:STE 205
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5000
Mailing Address - Country:US
Mailing Address - Phone:253-426-4520
Mailing Address - Fax:
Practice Address - Street 1:1624 S. I ST.
Practice Address - Street 2:STE 205
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5000
Practice Address - Country:US
Practice Address - Phone:253-426-4520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0245100OtherSTATE L&I
WAP00730570OtherRAILROAD
WA0245099OtherSTATE L&I
WA0245099OtherSTATE L&I