FMG Capitol Mall Drive Southwest Washington LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FMG CAPITOL MALL DRIVE SOUTHWEST WASHINGTON LLC

Practice address

4001 Capital Mall Dr SW
Olympia, WA 98502-8657

Phone

(360) 754-9792

Fax

(360) 754-2455

NPI assigned

Dec 18, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David C. Keating

Title

Agent

Phone

(414) 908-8058

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1215335591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 WEST LEMON STREET",
            "address_2": "C/O FOCUS MANAGEMENT GROUP",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336091103",
            "telephone_number": "813-281-0062",
            "fax_number": "813-281-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 CAPITAL MALL DR SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028657",
            "telephone_number": "360-754-9792",
            "fax_number": "360-754-2455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMG CAPITOL MALL DRIVE SOUTHWEST WASHINGTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KEATING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "414-908-8058"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennife Flores- Garcia
• Caroline Flores
• Virginia Flores
• Amanda R Flyckt, ARNP
• Brendan Flynn, CNIM
• Julie J. Fogliano, MSW
• Arthur Lee Foley III, M.D.
• Vivian L Folsom, MSS
• Meghan Fonken, PA-C
• Jutta Fonseca, MA61091263

• Skilled Nursing Facility in Olympia, WA
• Providers in Olympia, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.