Provider Demographics
NPI:1609880699
Name:CITY OF BRIDGEPORT
Entity Type:Organization
Organization Name:CITY OF BRIDGEPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRO
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:HAWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-842-8200
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-6310
Mailing Address - Country:US
Mailing Address - Phone:304-842-8223
Mailing Address - Fax:304-842-8254
Practice Address - Street 1:131 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1714
Practice Address - Country:US
Practice Address - Phone:304-842-8223
Practice Address - Fax:304-842-8254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0144729000Medicaid
WV0144729000Medicaid