Healthcare Provider Details

I. General information

NPI: 1679588362
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 253-382-8400
  • Fax: 253-382-8438
Mailing address:
  • Phone: 253-382-8400
  • Fax: 253-382-8438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN SPARE
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 253-779-6101