Provider Demographics
NPI:1417069808
Name:SPRINGFIELD FAMILY MEDICINE. LTD
Entity Type:Organization
Organization Name:SPRINGFIELD FAMILY MEDICINE. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRIDEAU
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:703-971-8600
Mailing Address - Street 1:6355 WALKER LN
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3245
Mailing Address - Country:US
Mailing Address - Phone:703-971-8600
Mailing Address - Fax:703-971-9043
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:SUITE 310
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-971-8600
Practice Address - Fax:703-971-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00521Medicare ID - Type Unspecified