Provider Demographics
NPI:1205236445
Name:BRIDGEPORT FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:BRIDGEPORT FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C0-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANDLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-603-9087
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 320
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:503-603-9087
Mailing Address - Fax:503-603-9122
Practice Address - Street 1:16083 SW UPPER BOONES FERRY RD
Practice Address - Street 2:STE 320
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7736
Practice Address - Country:US
Practice Address - Phone:503-603-9087
Practice Address - Fax:503-603-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO163558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1144515230OtherNPI
OR1699060780OtherNPI