# BRANCH MEDICAL CLINIC BRIDGEPORT

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NAVAL HOSPITAL TWENTYNINE PALMS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1083817597
- **Legal business name:** NAVAL HOSPITAL TWENTYNINE PALMS
- **Authorized official:** WILLIAM M CONDON (BUMED UBO)
- **Authorized official phone:** (240) 401-3643

## Contact information

- **Practice address:** MWTC BLDG 3005, BRIDGEPORT, CA 93517
- **Practice address phone:** (760) 830-2498
- **Practice address fax:** (760) 830-2182
- **Mailing address:** 1145 STURGESS STREET, BOX 788250, ATTN: FINANCIAL TECHNICIAN, TWENTYNINE PALMS, CA 92277-8250
- **Mailing address phone:** (760) 830-2498
- **Mailing address fax:** (760) 830-2182

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/11/2007
- **Last updated:** 10/16/2017