Healthcare Provider Details

I. General information

NPI: 1639405137
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 KIMBALL DR FL 2
GIG HARBOR WA
98335-1228
US

IV. Provider business mailing address

6401 KIMBALL DR FL 2
GIG HARBOR WA
98335-1228
US

V. Phone/Fax

Practice location:
  • Phone: 253-853-8810
  • Fax: 253-853-8820
Mailing address:
  • Phone: 253-853-8810
  • Fax: 253-853-8820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DAVID NOSACKA
Title or Position: CFO
Credential:
Phone: 618-641-5468