Basic Information
| Provider Information | |||||||||
| NPI: | 1174582530 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONDON FAMILY MEDICINE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1550 S 70TH ST STE 202 | ||||||||
| Address2: | PO BOX 67250 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685061576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023288833 | ||||||||
| FaxNumber: | 4023282921 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 PARK AVE | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | LONDON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431401121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7408457600 | ||||||||
| FaxNumber: | 7408457676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 11/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7408457600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000286657 | 01 | OH | ANTHEM BCBS | OTHER | DF3030 | 01 | OH | RRM | OTHER |