NPI | 1104246008 |
---|---|
Doing Business As | PROVIDENCE HEALTH EXPRESS AT BRIDGEPORT |
Entity Type | Organization |
Authorized Contact | KEENAN B FREEMAN CFO 503-893-6524 |
Organization Subpart ? | No |
Primary Taxonomy | 261Q00000X Clinic/Center |
Enumeration Date | 2014-04-18 |
Last Update Date | 2014-04-18 |