Provider Demographics
NPI:1821299314
Name:COLUMBIA FAMILY MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:COLUMBIA FAMILY MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:503-261-2618
Mailing Address - Street 1:5847 NE 122ND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1079
Mailing Address - Country:US
Mailing Address - Phone:503-256-3401
Mailing Address - Fax:503-261-2600
Practice Address - Street 1:5847 NE 122ND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1079
Practice Address - Country:US
Practice Address - Phone:503-256-3401
Practice Address - Fax:503-261-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
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
0000WCNBVMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER