Provider Demographics
NPI:1073080313
Name:BRIDGEWELL MEDICAL, INC.
Entity Type:Organization
Organization Name:BRIDGEWELL MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-505-1179
Mailing Address - Street 1:PO BOX 6795
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-0795
Mailing Address - Country:US
Mailing Address - Phone:208-505-1179
Mailing Address - Fax:
Practice Address - Street 1:800 W MAIN ST SUITE 1460
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-9030
Practice Address - Country:US
Practice Address - Phone:208-505-1179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2023-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty