Provider Demographics
NPI:1639405137
Name:FRANCISCAN MEDICAL GROUP
Entity Type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:FMG-GIG HARBOR ORTHOPAEDIC SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NOSACKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-641-5468
Mailing Address - Street 1:6401 KIMBALL DR FL 2
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1228
Mailing Address - Country:US
Mailing Address - Phone:253-853-8810
Mailing Address - Fax:253-853-8820
Practice Address - Street 1:6401 KIMBALL DR FL 2
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1228
Practice Address - Country:US
Practice Address - Phone:253-853-8810
Practice Address - Fax:253-853-8820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-19
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7149503Medicaid
WA7149503Medicaid
WAGAB08472Medicare PIN