Organization
BRIDGE CITY FAMILY MEDICAL CLINIC, PC
Active
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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