Provider Demographics
NPI:1568470441
Name:FRANCISCAN MEDICAL GROUP
Entity Type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:ST. FRANCIS BREAST CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-779-6101
Mailing Address - Street 1:34503 9TH AVE S
Mailing Address - Street 2:STE 320
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8727
Mailing Address - Country:US
Mailing Address - Phone:253-944-4280
Mailing Address - Fax:253-835-8000
Practice Address - Street 1:34503 9TH AVE S
Practice Address - Street 2:STE 320
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8727
Practice Address - Country:US
Practice Address - Phone:253-944-4280
Practice Address - Fax:253-835-8000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-04
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7129448Medicaid
WAG8808757Medicare PIN
WA1326440013Medicare NSC
WA7129448Medicaid