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Organization

BRIDGE CITY FAMILY MEDICAL CLINIC, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THERESA BUNKER FNP (OWNER)
(503) 460-0405
Entity
Organization

Contact information

Practice address
1410 NE 106TH AVE, PORTLAND, OR 97220-3934
(503) 460-0405
(503) 460-0434
Mailing address
1410 NE 106TH AVE, PORTLAND, OR 97220-3934
(503) 460-0405
(503) 460-0434

Taxonomy

Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
227362
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
227632
OR
Enumeration date
11/08/2006
Last updated
09/30/2011
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