Provider Demographics
NPI:1235108887
Name:RICHMOND FAMILY PRACTICE, P.C.
Entity Type:Organization
Organization Name:RICHMOND FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-727-3275
Mailing Address - Street 1:35008 DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-1565
Mailing Address - Country:US
Mailing Address - Phone:586-727-3275
Mailing Address - Fax:586-727-3207
Practice Address - Street 1:35008 DIVISION RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1565
Practice Address - Country:US
Practice Address - Phone:586-727-3275
Practice Address - Fax:586-727-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E06119Medicare ID - Type Unspecified