=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851341077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CEDAR FAMILY MEDICINE, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2006
-----------------------------------------------------
Last Update Date | 08/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1404 NE 134TH ST #170
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98685-2799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-573-1381
-----------------------------------------------------
Fax | 360-573-1384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1404 NE 134TH ST #170
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98685-2799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-573-1381
-----------------------------------------------------
Fax | 360-573-1384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CYNTHIA WOODSON COLVEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 360-573-1381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD00032812
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------