Provider Demographics
NPI:1962858464
Name:ALL SEASONS FAMILY MEDICINE PC
Entity type:Organization
Organization Name:ALL SEASONS FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PINSONNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-935-2035
Mailing Address - Street 1:PO BOX 1539
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-1539
Mailing Address - Country:US
Mailing Address - Phone:541-935-2035
Mailing Address - Fax:541-935-6608
Practice Address - Street 1:25045 DUNHAM AVE.
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487
Practice Address - Country:US
Practice Address - Phone:541-935-2035
Practice Address - Fax:541-935-6608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO27753305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279166Medicaid
ORR142338Medicare PIN