Healthcare Provider Details

I. General information

NPI: 1386970879
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: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 S J ST FL 4
TACOMA WA
98405-4930
US

IV. Provider business mailing address

1608 S J ST FL 4
TACOMA WA
98405-4930
US

V. Phone/Fax

Practice location:
  • Phone: 253-274-7504
  • Fax: 253-274-7994
Mailing address:
  • Phone: 253-274-7504
  • Fax: 253-274-7994

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: CHIEF FINANCIAL OFFICER
Credential:
Phone: 253-680-4005