Healthcare Provider Details

I. General information

NPI: 1356560056
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34709 9TH AVE S STE B500
FEDERAL WAY WA
98003-6789
US

IV. Provider business mailing address

34709 9TH AVE S STE B500
FEDERAL WAY WA
98003-6789
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-8552
  • Fax: 253-874-6089
Mailing address:
  • Phone: 253-838-8552
  • Fax: 253-874-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERTA JO WITTORF
Title or Position: REGIONAL VP FINANCE, NORTHWEST
Credential:
Phone: 509-551-5319