Basic Information
| Provider Information | |||||||||
| NPI: | 1558692319 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRANCISCAN MEDICAL GROUP | ||||||||
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| OtherOrganizationName: | FMG HOSPITALIST UROLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34935 | ||||||||
| Address2: | DEPT 121 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539856346 | ||||||||
| FaxNumber: | 2539856137 | ||||||||
| Practice Location | |||||||||
| Address1: | 6401 KIMBALL DR | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539856346 | ||||||||
| FaxNumber: | 2539856137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2010 | ||||||||
| LastUpdateDate: | 06/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | MARSH | ||||||||
| AuthorizedOfficialFirstName: | TIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATIONS OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2537796102 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.