Provider Demographics
NPI:1942378658
Name:LYNN MADSEN PC
Entity Type:Organization
Organization Name:LYNN MADSEN PC
Other - Org Name:BE WELL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-404-6862
Mailing Address - Street 1:2320 SW BENZ FARM CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-3102
Mailing Address - Country:US
Mailing Address - Phone:971-404-6862
Mailing Address - Fax:503-914-0341
Practice Address - Street 1:2320 SW BENZ FARM CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-3102
Practice Address - Country:US
Practice Address - Phone:971-404-6862
Practice Address - Fax:503-914-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR19524169668OtherINDIV NPI
OR19524169668OtherINDIV NPI