Provider Demographics
NPI:1891700589
Name:FRANCISCAN MEDICAL GROUP
Entity Type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:ALL FAMILY MEDICINE
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 1:11025 CANYON RD E
Mailing Address - Street 2:STE C
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4264
Mailing Address - Country:US
Mailing Address - Phone:253-536-1020
Mailing Address - Fax:253-536-1612
Practice Address - Street 1:11025 CANYON RD E
Practice Address - Street 2:STE C
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4264
Practice Address - Country:US
Practice Address - Phone:253-536-1020
Practice Address - Fax:253-536-1612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7117583Medicaid
WA0205195OtherSTATE L&I
WA7117583Medicaid
WA0205195OtherSTATE L&I