Provider Demographics
NPI:1023437803
Name:BRIGHT MEDICINE CLINIC
Entity type:Organization
Organization Name:BRIGHT MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:971-231-4325
Mailing Address - Street 1:827 NE ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4578
Mailing Address - Country:US
Mailing Address - Phone:971-231-4325
Mailing Address - Fax:971-239-1913
Practice Address - Street 1:827 NE ALBERTA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-4578
Practice Address - Country:US
Practice Address - Phone:971-231-4325
Practice Address - Fax:971-239-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1842261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center