Provider Demographics
NPI:1508151614
Name:FAMILY HEALTH PRACTITIONERS CLINIC PC
Entity Type:Organization
Organization Name:FAMILY HEALTH PRACTITIONERS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:INMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:503-263-6611
Mailing Address - Street 1:143 NW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3101
Mailing Address - Country:US
Mailing Address - Phone:503-263-6611
Mailing Address - Fax:503-266-5674
Practice Address - Street 1:143 NW 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3101
Practice Address - Country:US
Practice Address - Phone:503-263-6611
Practice Address - Fax:503-266-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty