Provider Demographics
NPI:1740784214
Name:BRIDGE INTEGRATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:BRIDGE INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WYLLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-454-5433
Mailing Address - Street 1:305 NW ENGLEWOOD COURT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4000
Mailing Address - Country:US
Mailing Address - Phone:816-454-5433
Mailing Address - Fax:816-454-8455
Practice Address - Street 1:305 NW ENGLEWOOD CT STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118
Practice Address - Country:US
Practice Address - Phone:816-454-5433
Practice Address - Fax:816-454-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty