Provider Demographics
NPI:1881347706
Name:CATALPA CLINIC PLLC
Entity type:Organization
Organization Name:CATALPA CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:WOOLDRIDGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:360-362-0170
Mailing Address - Street 1:2528 WHEATON WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3305
Mailing Address - Country:US
Mailing Address - Phone:360-362-0170
Mailing Address - Fax:360-995-0304
Practice Address - Street 1:2528 WHEATON WAY STE 203
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3305
Practice Address - Country:US
Practice Address - Phone:360-362-0170
Practice Address - Fax:360-995-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care