Provider Demographics
NPI:1932302262
Name:BRANCH MEDICAL CLINIC BANGOR
Entity Type:Organization
Organization Name:BRANCH MEDICAL CLINIC BANGOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUMED UBO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3643
Mailing Address - Street 1:1 BOONE RD
Mailing Address - Street 2:CODE 08RAZD
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1894
Mailing Address - Country:US
Mailing Address - Phone:360-475-4160
Mailing Address - Fax:360-475-4676
Practice Address - Street 1:2050 BARB ST
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98315
Practice Address - Country:US
Practice Address - Phone:360-315-4391
Practice Address - Fax:360-396-4247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL BREMERTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-06
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient