Provider Demographics
NPI:1497978100
Name:FRANCISCAN HEALTH SYSTEM
Entity Type:Organization
Organization Name:FRANCISCAN HEALTH SYSTEM
Other - Org Name:ST JOSEPH HOSPITAL PSYCHIATRIC PROFESSIONAL SERVICES
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:253-426-6691
Mailing Address - Fax:253-426-6492
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:253-426-6691
Practice Address - Fax:253-426-6492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-11
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021407273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8910986OtherSTATE CRIME VICTIMS
WA078200OtherSTATE L&I
WA7023369Medicaid