Provider Demographics
NPI:1336164631
Name:FRANCISCAN HEALTH SYSTEM
Entity Type:Organization
Organization Name:FRANCISCAN HEALTH SYSTEM
Other - Org Name:ST. JOSPEH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ECO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILCZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-426-6989
Mailing Address - Street 1:PO BOX 31001-1440
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-1440
Mailing Address - Country:US
Mailing Address - Phone:253-573-7143
Mailing Address - Fax:253-573-7059
Practice Address - Street 1:702 S HILL PARK DR STE 105
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1426
Practice Address - Country:US
Practice Address - Phone:253-573-7143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3990561Medicaid
WA3990561Medicaid