| Organization Name: | PHILOMATH FAMILY MEDICINE, P.C. |
| NPI Number: | 1003957911 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNY HEINE (DIRECTOR OF OPERATIONS) |
| Mailing Address: | 1219 Applegate Philomath |
| State: | OR US |
| Postal Code: | 97370 |
| Phone Number: | 5419292922 |
| Fax Number: | |
| NPI Enumeration Date: | 02/12/2007 |
| NPI Last Update Date: | 10/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332900000X |
| License Number: | MD10373 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Non-Pharmacy Dispensing Site |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |