Provider Demographics
NPI:1598712796
Name:BRIDGES SURGICAL GROUP LLC
Entity Type:Organization
Organization Name:BRIDGES SURGICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-461-7500
Mailing Address - Street 1:1900 NEBRASKA AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4837
Mailing Address - Country:US
Mailing Address - Phone:772-461-7500
Mailing Address - Fax:
Practice Address - Street 1:1900 NEBRASKA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4837
Practice Address - Country:US
Practice Address - Phone:772-461-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94791OtherBCBS OF FL
FL=========OtherTRICARE STANDARD
FL94791Medicare ID - Type Unspecified