Provider Demographics
NPI:1851341077
Name:CEDAR FAMILY MEDICINE, INCORPORATED
Entity Type:Organization
Organization Name:CEDAR FAMILY MEDICINE, INCORPORATED
Other - Org Name:FAMILY HEALTH CLINIC, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:WOODSON
Authorized Official - Last Name:COLVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-573-1381
Mailing Address - Street 1:1404 NE 134TH ST
Mailing Address - Street 2:#170
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2799
Mailing Address - Country:US
Mailing Address - Phone:360-573-1381
Mailing Address - Fax:360-573-1384
Practice Address - Street 1:1404 NE 134TH ST
Practice Address - Street 2:#170
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2799
Practice Address - Country:US
Practice Address - Phone:360-573-1381
Practice Address - Fax:360-573-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8802591Medicare ID - Type Unspecified