Provider Demographics
NPI:1063509446
Name:RICHLAND FAMILY MEDICINE PS
Entity Type:Organization
Organization Name:RICHLAND FAMILY MEDICINE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-946-9664
Mailing Address - Street 1:1215 GEORGE WASHINGTON WAY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3442
Mailing Address - Country:US
Mailing Address - Phone:509-946-9664
Mailing Address - Fax:
Practice Address - Street 1:1215 GEORGE WASHINGTON WAY
Practice Address - Street 2:SUITE #1
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3442
Practice Address - Country:US
Practice Address - Phone:509-946-9664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD17852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7199904Medicaid
WA65129OtherGROUP HEALTH
WA080069900OtherRR MEDICARE
WA17383OtherWA DEPT OF L&I
WA000301328Medicare ID - Type Unspecified