Provider Demographics
NPI:1174582530
Name:LONDON FAMILY MEDICINE, INC.
Entity type:Organization
Organization Name:LONDON FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-845-7600
Mailing Address - Street 1:1550 S 70TH ST STE 202
Mailing Address - Street 2:PO BOX 67250
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1576
Mailing Address - Country:US
Mailing Address - Phone:402-328-8833
Mailing Address - Fax:402-328-2921
Practice Address - Street 1:55 PARK AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1121
Practice Address - Country:US
Practice Address - Phone:740-845-7600
Practice Address - Fax:740-845-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000286657OtherANTHEM BCBS
OHDF3030OtherRRM
OH=========00OtherDOL WORKERS COMP
OH=========00OtherDOL WORKERS COMP