Provider Demographics
NPI:1881215622
Name:BRIDGE DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:BRIDGE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR RCM AND PAYOR RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CHC
Authorized Official - Phone:678-468-7047
Mailing Address - Street 1:120 VANTIS DR STE 570
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2618
Mailing Address - Country:US
Mailing Address - Phone:800-803-1611
Mailing Address - Fax:
Practice Address - Street 1:120 VANTIS DR STE 570
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2618
Practice Address - Country:US
Practice Address - Phone:800-803-1611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory