MEDICARE: FRANCISCAN MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician
2	207V00000X	Obstetrics & Gynecology Physician
3	2084P0800X	Psychiatry Physician	WA
4	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0126534	OTHER	WA	STATE L&I

General Provider Information

NPI Number	:	1376572065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANCISCAN MEDICAL GROUP

Provider Business Mailing Address
First Line	:	7210 40TH ST W
Second Line	:	STE 100
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4318
Country	:	US
Telephone Number	:	253-564-0170
Fax Number	:

Provider Business Practice Location Address
First Line	:	7210 40TH ST W
Second Line	:	STE 100
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4318
Country	:	US
Telephone Number	:	253-564-0170
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	CLIFF A ROBERTSON
Credential	:	MD
Telephone Number	:	253-779-6101

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	06/24/2009

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Directions to “FRANCISCAN MEDICAL GROUP ” Practice Location

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