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General NPI Number Information
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NPI Number | 1629899448
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Entity Type | Organization
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Legal Business Name | MATTHEW'S FAMILY PRIMARY CARE, LLC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 18514 SE WILMOT ST UNIT B
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City | MILWAUKIE
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State | OR
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Zip | 97267-6426
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Country | US
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Telephone | 678-793-8808
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Fax |
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Provider Business Mailing Address
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Address Line | 18514 SE WILMOT ST UNIT B
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City | MILWAUKIE
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State | OR
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Zip | 97267-6426
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Country | US
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Telephone | 678-793-8808
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Fax |
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Authorized Official
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Title or Position | OWNER, DIRECTOR
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Name | DR. BERHANU EJIGU KEDEDA
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Credential | FNP, AGACNP, DNP
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Telephone | 678-793-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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