Provider Demographics
NPI:1154656940
Name:BRIDGES MEDICAL SERVICES P.C.
Entity Type:Organization
Organization Name:BRIDGES MEDICAL SERVICES P.C.
Other - Org Name:BRIDGES MEDICAL SERVICES-BRANSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:CULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-546-4200
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MO
Mailing Address - Zip Code:65653-1240
Mailing Address - Country:US
Mailing Address - Phone:417-546-4200
Mailing Address - Fax:417-546-4505
Practice Address - Street 1:1440 STATE HIGHWAY 248 STE O
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-9257
Practice Address - Country:US
Practice Address - Phone:417-239-0706
Practice Address - Fax:417-239-0768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-12
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268917Medicare PIN