Healthcare Provider Details

I. General information

NPI: 1649285339
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: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34709 9TH AVE S #B-500
FEDERAL WAY WA
98003-8722
US

IV. Provider business mailing address

34709 9TH AVE S #B-500
FEDERAL WAY WA
98003-8722
US

V. Phone/Fax

Practice location:
  • Phone: 253-944-6950
  • Fax: 253-661-8603
Mailing address:
  • Phone: 253-944-6950
  • Fax: 253-661-8603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

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