Healthcare Provider Details

I. General information

NPI: 1164437851
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AUBURN AVE
AUBURN WA
98002-5015
US

IV. Provider business mailing address

200 AUBURN AVE
AUBURN WA
98002-5015
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-1986
  • Fax: 253-939-0521
Mailing address:
  • Phone: 253-833-1986
  • Fax: 253-939-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00029862
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000816
License Number StateWA

VIII. Authorized Official

Name: CLIFF ROBERTSON
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 253-779-6101