Provider Demographics
NPI:1861473134
Name:BRIDGET P. EARLY, MD, LLC
Entity Type:Organization
Organization Name:BRIDGET P. EARLY, MD, LLC
Other - Org Name:NAMASTE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:P
Authorized Official - Last Name:EARLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-657-7330
Mailing Address - Street 1:2100 E BROADWAY STE 108
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6082
Mailing Address - Country:US
Mailing Address - Phone:573-657-7330
Mailing Address - Fax:573-657-1772
Practice Address - Street 1:2100 E BROADWAY STE 108
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6082
Practice Address - Country:US
Practice Address - Phone:573-657-7330
Practice Address - Fax:573-657-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507374205Medicaid
MO000014728Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER