Provider Demographics
NPI:1558478818
Name:FRANCISCAN MEDICAL GROUP
Entity type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-858-9192
Mailing Address - Street 1:451 SW SEDGWICK RD
Mailing Address - Street 2:STE 110
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367
Mailing Address - Country:US
Mailing Address - Phone:360-874-5900
Mailing Address - Fax:360-874-5959
Practice Address - Street 1:451 SW SEDGWICK RD
Practice Address - Street 2:STE 110
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367
Practice Address - Country:US
Practice Address - Phone:360-874-5900
Practice Address - Fax:360-874-5959
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-24
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7132459Medicaid
WA0207870OtherSTATE L&I
WA8928223OtherSTATE CRIME VICTIMS
WA1326440032Medicare NSC
WA7132459Medicaid
WAG8861997Medicare PIN