Provider Demographics
NPI:1740425768
Name:FRANCISCAN MEDICAL GROUPG
Entity Type:Organization
Organization Name:FRANCISCAN MEDICAL GROUPG
Other - Org Name:FMG-FRANCISCAN SURGICAL ASSOCIATES (GH)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-858-9192
Mailing Address - Street 1:6401 KIMBALL DR
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:253-426-4775
Mailing Address - Fax:253-426-4799
Practice Address - Street 1:6401 KIMBALL DR
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:253-426-4775
Practice Address - Fax:253-426-4799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-04
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8806017Medicare PIN