| Bridgeway-woodburn | |
|
11656 Sublimity Rd Se Sublimity OR 97385-9534 | |
| (503) 238-0769 | |
| (503) 889-2599 |
| Full Name | Bridgeway-woodburn |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 11656 Sublimity Rd Se, Sublimity, Oregon |
| Authorized Official Name and Position | Enrique Sama (VP, HUMAN RESOURCES) |
| Authorized Official Contact | 5039637791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeway-woodburn Po Box 8459 Portland OR 97207-8459 Ph: (503) 238-0769 | Bridgeway-woodburn 11656 Sublimity Rd Se Sublimity OR 97385-9534 Ph: (503) 238-0769 |
| NPI Number | 1720034853 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 06/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720034853 | NPI | - | NPPES |
| 223347 | Medicaid | OR | |
| 226398 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Sublimity Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 114 Se Church St, Sublimity, OR 97385 Phone: 503-769-2259 | |
Sublimity Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 114 Se Church St, Sublimity, OR 97385 Phone: 503-769-2259 Fax: 503-769-8049 |