1851350300 NPI number — BRIDGES HEALTHCARE INC.

Table of content: (NPI 1851350300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851350300 NPI number — BRIDGES HEALTHCARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIDGES HEALTHCARE INC.
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:
1851350300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
949 BRIDGEPORT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06460-3142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-878-6365
Provider Business Mailing Address Fax Number:
203-301-2397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
949 BRIDGEPORT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06460-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-878-6365
Provider Business Practice Location Address Fax Number:
203-301-2397
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FIORILLO
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
203-878-6365

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  0316 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X , with the licence number: 0313 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: 0314 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: C0034 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 77ABH0005CT01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 165319 . This is a "VALUE OPTIONS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: ANC 1406 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004039244 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118591000 . This is a "MAGELLAN PROVIDER NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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