1972722510 NPI number — FRANCISCAN MEDICAL GROUP

Table of content: (NPI 1972722510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972722510 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:
Provider Other Organization Name Type Code:
6
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:
1972722510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16233 SYLVESTER RD SW
Provider Second Line Business Mailing Address:
#G-10
Provider Business Mailing Address City Name:
BURIEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98166-3045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-242-6553
Provider Business Mailing Address Fax Number:
206-426-0468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16233 SYLVESTER RD SW
Provider Second Line Business Practice Location Address:
#G-10
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-242-6553
Provider Business Practice Location Address Fax Number:
206-426-0468
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTSON
Authorized Official First Name:
CLIFF
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT AND CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
253-779-6101

Provider Taxonomy Codes

  • Taxonomy code: 207XX0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0223400 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7137110 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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