Healthcare Provider Details

I. General information

NPI: 1457554776
Provider Name (Legal Business Name): BRANCH MEDICAL CLINIC PUGET SOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FARRAGUT AVE BLDG 940
BREMERTON WA
98314
US

IV. Provider business mailing address

1 BOONE RD CODE 08RAZD
BREMERTON WA
98312-1894
US

V. Phone/Fax

Practice location:
  • Phone: 360-476-2508
  • Fax: 360-476-2480
Mailing address:
  • Phone: 360-475-4160
  • Fax: 360-475-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M CONDON
Title or Position: BUMED UBO
Credential:
Phone: 240-401-3643