1881830164 NPI number — FRANCISCAN MEDICAL GROUP

Table of content: (NPI 1881830164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881830164 NPI number — FRANCISCAN MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANCISCAN MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FMG-CARLOS E MORAVEK, MD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881830164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 S UNION AVE
Provider Second Line Business Mailing Address:
SUITE B-7011
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-627-0762
Provider Business Mailing Address Fax Number:
253-572-9560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 S UNION AVE
Provider Second Line Business Practice Location Address:
SUITE B-7011
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-627-0762
Provider Business Practice Location Address Fax Number:
253-572-9560
Provider Enumeration Date:
12/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBERTSON
Authorized Official First Name:
CLIFF
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
253-680-4015

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  MD00035329 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)