Provider Demographics
NPI:1700220126
Name:FRANCISCAN HEALTH SYSTEM
Entity Type:Organization
Organization Name:FRANCISCAN HEALTH SYSTEM
Other - Org Name:ST JOSEPH MEDICAL CENTER- SOUTH DIL
Other - Org Type:Doing Business As
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:253-680-4002
Mailing Address - Street 1:PO BOX 31001-1462
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-1462
Mailing Address - Country:US
Mailing Address - Phone:253-573-7107
Mailing Address - Fax:253-573-7059
Practice Address - Street 1:5825 TACOMA MALL BLVD
Practice Address - Street 2:SUITE # 103
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6906
Practice Address - Country:US
Practice Address - Phone:253-573-7107
Practice Address - Fax:253-573-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA503512Medicare Oscar/Certification