Healthcare Provider Details

I. General information

NPI: 1134437668
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 WESTGATE BLVD STE 230
TACOMA WA
98406-2570
US

IV. Provider business mailing address

PO BOX 31001-1518
PASADENA CA
91110-1518
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-2244
  • Fax: 253-761-1040
Mailing address:
  • Phone: 253-552-4100
  • Fax: 253-552-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN FIELD
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 253-858-9192