Healthcare Provider Details

I. General information

NPI: 1962036467
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 FAUNTLEROY WAY SW STE 110
SEATTLE WA
98116-4669
US

IV. Provider business mailing address

PO BOX 31001-1518
PASADENA CA
91110-1518
US

V. Phone/Fax

Practice location:
  • Phone: 206-201-0551
  • Fax: 206-201-0552
Mailing address:
  • Phone: 253-779-6260
  • Fax: 253-779-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MIKE FITZGERALD
Title or Position: CFO
Credential:
Phone: 253-680-4005