Provider Demographics
NPI:1649285339
Name:FRANCISCAN MEDICAL GROUP
Entity type:Organization
Organization Name:FRANCISCAN MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:
Authorized Official - Phone:253-779-6101
Mailing Address - Street 1:34709 9TH AVE S
Mailing Address - Street 2:#B-500
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8722
Mailing Address - Country:US
Mailing Address - Phone:253-944-6950
Mailing Address - Fax:253-661-8603
Practice Address - Street 1:34709 9TH AVE S
Practice Address - Street 2:#B-500
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8722
Practice Address - Country:US
Practice Address - Phone:253-944-6950
Practice Address - Fax:253-661-8603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0184424OtherSTATE L&I
WA7119795Medicaid
WA7119795Medicaid
WAAB39608Medicare ID - Type Unspecified
WA1326440015Medicare NSC