Healthcare Provider Details

I. General information

NPI: 1962417659
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: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2748 MILTON WAY STE 101
MILTON WA
98354-9382
US

IV. Provider business mailing address

2748 MILTON WAY STE 101
MILTON WA
98354-9382
US

V. Phone/Fax

Practice location:
  • Phone: 253-922-5262
  • Fax: 253-922-5299
Mailing address:
  • Phone: 253-922-5262
  • Fax: 253-922-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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