Provider Demographics
NPI:1679872220
Name:BRIDGEWAY HEALTH SOLUTIONS OF ARIZONA, INC.
Entity Type:Organization
Organization Name:BRIDGEWAY HEALTH SOLUTIONS OF ARIZONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHOREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-720-5567
Mailing Address - Street 1:1850 W RIO SALADO PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-2165
Mailing Address - Country:US
Mailing Address - Phone:520-546-3400
Mailing Address - Fax:
Practice Address - Street 1:1850 W RIO SALADO PKWY
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2165
Practice Address - Country:US
Practice Address - Phone:520-546-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTENE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3835302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization