# LESLIE CANYON FAMILY MEDICINE, P.S.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538349030
- **Authorized official:** DR. LUCIEN T MEGNA MD (PRESIDIENT / CEO)
- **Authorized official phone:** (509) 628-2331

## Contact information

- **Practice address:** 705 GAGE BLVD, SUITE 200, RICHLAND, WA 99352-9701
- **Practice address phone:** (509) 628-2331
- **Practice address fax:** (509) 628-0537
- **Mailing address:** 705 GAGE BLVD, SUITE 200, RICHLAND, WA 99352-9701
- **Mailing address phone:** (509) 628-2331
- **Mailing address fax:** (509) 628-0537

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | WA00034155 | WA | Yes |

## Other

- **Enumeration date:** 11/13/2007
- **Last updated:** 06/21/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 11151316 | CAQH | — |
| 05 | — | 7077993 | — | WA |