Healthcare Provider Details

I. General information

NPI: 1174582530
Provider Name (Legal Business Name): LONDON FAMILY MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PARK AVE SUITE 230
LONDON OH
43140-1121
US

IV. Provider business mailing address

1550 S 70TH ST STE 202 PO BOX 67250
LINCOLN NE
68506-1576
US

V. Phone/Fax

Practice location:
  • Phone: 740-845-7600
  • Fax: 740-845-7676
Mailing address:
  • Phone: 402-328-8833
  • Fax: 402-328-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN G RICHARDSON
Title or Position: OWNER
Credential: MD
Phone: 740-845-7600