Provider Demographics
NPI:1346327178
Name:BRIDGES MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:BRIDGES MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAILEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:LEGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-319-6756
Mailing Address - Street 1:8987 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777
Mailing Address - Country:US
Mailing Address - Phone:727-319-6756
Mailing Address - Fax:727-393-9070
Practice Address - Street 1:8987 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777
Practice Address - Country:US
Practice Address - Phone:727-319-6756
Practice Address - Fax:727-393-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1570332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4413770001Medicare NSC