Provider Demographics
NPI:1508572348
Name:BRIDGES HEALTHCARE LLC
Entity Type:Organization
Organization Name:BRIDGES HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANA
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:802-307-9998
Mailing Address - Street 1:861 WILLISTON RD STE 8
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5724
Mailing Address - Country:US
Mailing Address - Phone:802-307-9998
Mailing Address - Fax:352-353-0910
Practice Address - Street 1:145 PINE HAVEN SHORES RD STE 1000-54
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7703
Practice Address - Country:US
Practice Address - Phone:802-307-9998
Practice Address - Fax:352-353-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1295147924Medicaid