1699804211 NPI number — BRIDGETOWN HEARING CLINIC

Table of content: (NPI 1699804211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699804211 NPI number — BRIDGETOWN HEARING CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIDGETOWN HEARING CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699804211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 NE 20TH AVE
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97232-2275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-528-6849
Provider Business Mailing Address Fax Number:
503-234-4227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 NE 20TH AVE
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97232-2275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-528-6849
Provider Business Practice Location Address Fax Number:
503-234-4227
Provider Enumeration Date:
03/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HART
Authorized Official First Name:
RENATE
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER-MANAGER
Authorized Official Telephone Number:
503-528-6849

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 231HA2400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 231HA2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)