Provider Demographics
NPI:1336119544
Name:CITY OF BRIDGEWATER
Entity Type:Organization
Organization Name:CITY OF BRIDGEWATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:PRINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-729-2690
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:232 N MAIN AVE
Mailing Address - City:BRIDGEWATER
Mailing Address - State:SD
Mailing Address - Zip Code:57319-0037
Mailing Address - Country:US
Mailing Address - Phone:605-729-2690
Mailing Address - Fax:605-729-2090
Practice Address - Street 1:232 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:SD
Practice Address - Zip Code:57319-0037
Practice Address - Country:US
Practice Address - Phone:605-729-2690
Practice Address - Fax:605-729-2090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF BRIDGEWATER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-23
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4613416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9000910Medicaid
SD99094Medicare ID - Type Unspecified