Provider Demographics
NPI:1336386473
Name:FRANCISCAN MEDICAL GROUP
Entity Type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:FMG-THORACIC AND VASCULAR CENTER OF KITSAP CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-779-6101
Mailing Address - Street 1:1225 CAMPBELL WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3351
Mailing Address - Country:US
Mailing Address - Phone:360-479-4203
Mailing Address - Fax:360-478-7240
Practice Address - Street 1:1225 CAMPBELL WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3351
Practice Address - Country:US
Practice Address - Phone:360-479-4203
Practice Address - Fax:360-478-7240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty