Provider Demographics
NPI:1134237696
Name:FRANCISCAN MEDICAL GROUP
Entity type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CHIEF MEDICAL OFFICE
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 1:200 S 333RD ST
Mailing Address - Street 2:STE 150
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7359
Mailing Address - Country:US
Mailing Address - Phone:253-275-6030
Mailing Address - Fax:253-946-0428
Practice Address - Street 1:200 S 333RD ST
Practice Address - Street 2:STE 150
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7359
Practice Address - Country:US
Practice Address - Phone:253-275-6030
Practice Address - Fax:253-946-0428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-26
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027211208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7134257Medicaid
WA7134257Medicaid
WA8861921Medicare ID - Type Unspecified