Provider Demographics
NPI:1336313923
Name:FAMILY MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:FAMILY MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNDEN
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-231-0014
Mailing Address - Street 1:5646 SE HILLWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-4141
Mailing Address - Country:US
Mailing Address - Phone:503-784-5905
Mailing Address - Fax:541-644-5000
Practice Address - Street 1:600 N 5TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2876
Practice Address - Country:US
Practice Address - Phone:503-784-5905
Practice Address - Fax:541-644-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO15187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000WCRDCOtherMEDICARE #
OR161970Medicaid
OR161970Medicaid