Healthcare Provider Details

I. General information

NPI: 1699131581
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 S J ST SUITE 120
TACOMA WA
98405-4964
US

IV. Provider business mailing address

1812 S J ST SUITE 120
TACOMA WA
98405-4964
US

V. Phone/Fax

Practice location:
  • Phone: 253-428-2200
  • Fax: 253-428-2299
Mailing address:
  • Phone: 253-428-2200
  • Fax: 253-428-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

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