Healthcare Provider Details

I. General information

NPI: 1528216280
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 COLE ST
ENUMCLAW WA
98022-3504
US

IV. Provider business mailing address

1818 COLE ST
ENUMCLAW WA
98022-3504
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-8032
  • Fax: 253-833-8081
Mailing address:
  • Phone: 253-833-8032
  • Fax: 253-833-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CLIFF A. ROBERTSON
Title or Position: PRESIDENT
Credential: MD
Phone: 253-779-6101