Provider Demographics
NPI:1821105271
Name:FRANCISCAN MEDICAL GROUP
Entity Type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:PACIFIC NW MATERNAL FETAL MEDICINE FEDERAL WAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-779-6101
Mailing Address - Street 1:34503 9TH AVE S
Mailing Address - Street 2:STE 200
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8727
Mailing Address - Country:US
Mailing Address - Phone:253-835-6260
Mailing Address - Fax:253-835-6299
Practice Address - Street 1:34503 9TH AVE S
Practice Address - Street 2:STE 200
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8727
Practice Address - Country:US
Practice Address - Phone:253-835-6260
Practice Address - Fax:253-835-6299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-23
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023541207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0214670OtherSTATE L&I
WA7134364Medicaid
WA0214670OtherSTATE L&I
WAG8865737Medicare PIN