Provider Demographics
NPI:1902854029
Name:FRANCISCAN MEDICAL GROUP
Entity Type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:ST. FRANCIS MEDICAL CLINIC
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:MD
Authorized Official - Phone:253-779-6101
Mailing Address - Street 1:34503 9TH AVE S
Mailing Address - Street 2:STE 100
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8727
Mailing Address - Country:US
Mailing Address - Phone:253-874-2227
Mailing Address - Fax:253-835-8000
Practice Address - Street 1:34503 9TH AVE S
Practice Address - Street 2:STE 100
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8727
Practice Address - Country:US
Practice Address - Phone:253-874-2227
Practice Address - Fax:253-835-8000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-04
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7095144Medicaid
WA8945603OtherSTATE CRIME VICTIMS
WAG8862207Medicare PIN
WAG8808757Medicare PIN
WA8945603OtherSTATE CRIME VICTIMS
WA1326440004Medicare NSC