Basic Information
| Provider Information | |||||||||
| NPI: | 1821363300 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRANCISCAN HEALTH SYSTEM | ||||||||
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| OtherOrganizationName: | ST JOSEPH CARDIOTHORACIC SURGEONS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11511 CANTERWOOD BLVD NW | ||||||||
| Address2: | SUITE 50 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983325813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535302939 | ||||||||
| FaxNumber: | 2534264142 | ||||||||
| Practice Location | |||||||||
| Address1: | 11511 CANTERWOOD BLVD NW | ||||||||
| Address2: | SUITE 50 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983325813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535302939 | ||||||||
| FaxNumber: | 2534264142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2012 | ||||||||
| LastUpdateDate: | 03/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | FITZGERALD | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2536804005 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.