Basic Information
| Provider Information | |||||||||
| NPI: | 1932412293 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRANCISCAN MEDICAL GROUP | ||||||||
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| OtherOrganizationName: | UW TACOMA STUDENT HEALTH SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 COMMERCE ST | ||||||||
| Address2: | BOX 358423 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984023112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535524102 | ||||||||
| FaxNumber: | 2535524175 | ||||||||
| Practice Location | |||||||||
| Address1: | 1742 MARKET ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984023213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535524102 | ||||||||
| FaxNumber: | 2535524175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2010 | ||||||||
| LastUpdateDate: | 07/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | FIELD | ||||||||
| AuthorizedOfficialFirstName: | DEAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT, CMO | ||||||||
| AuthorizedOfficialTelephone: | 2536804009 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FRANCISCAN MEDICAL GROUP | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.