Healthcare Provider Details

I. General information

NPI: 1376572065
Provider Name (Legal Business Name): FRANCISCAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 40TH ST W STE 100
UNIVERSITY PLACE WA
98466-4318
US

IV. Provider business mailing address

7210 40TH ST W STE 100
UNIVERSITY PLACE WA
98466-4318
US

V. Phone/Fax

Practice location:
  • Phone: 253-564-0170
  • Fax:
Mailing address:
  • Phone: 253-564-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: CLIFF A ROBERTSON
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 253-779-6101