Healthcare Provider Details

I. General information

NPI: 1194099051
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 PORT OF TACOMA RD
TACOMA WA
98421-3707
US

IV. Provider business mailing address

1930 PORT OF TACOMA RD
TACOMA WA
98421-3707
US

V. Phone/Fax

Practice location:
  • Phone: 253-274-5521
  • Fax: 253-274-5525
Mailing address:
  • Phone: 253-574-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN SPARE
Title or Position: PRESIDENT AND CMO
Credential: MD
Phone: 253-680-4008