Provider Demographics
NPI:1659476000
Name:BAINBRIDGE ORTHOPAEDIC CLINIC
Entity Type:Organization
Organization Name:BAINBRIDGE ORTHOPAEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:DELL
Authorized Official - Last Name:BAINBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-381-7200
Mailing Address - Street 1:PO BOX 5500
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802
Mailing Address - Country:US
Mailing Address - Phone:308-381-7200
Mailing Address - Fax:308-382-3335
Practice Address - Street 1:820 ALPHA ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-381-7200
Practice Address - Fax:308-382-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025176800Medicaid
099623Medicare ID - Type Unspecified
NE10025176800Medicaid