Provider Demographics
NPI:1902979248
Name:JUDITH RICHMOND MD PC
Entity Type:Organization
Organization Name:JUDITH RICHMOND MD PC
Other - Org Name:OREGON BREAST CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-697-3255
Mailing Address - Street 1:8950 SW NIMBUS AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7478
Mailing Address - Country:US
Mailing Address - Phone:503-697-3255
Mailing Address - Fax:503-697-7792
Practice Address - Street 1:8950 SW NIMBUS AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7478
Practice Address - Country:US
Practice Address - Phone:503-697-3255
Practice Address - Fax:503-697-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022775Medicaid
ORF00470Medicare UPIN
OR022775Medicaid