Provider Demographics
NPI:1922061571
Name:WILLIAM C BRIDGES MD & ASSOCIATES
Entity Type:Organization
Organization Name:WILLIAM C BRIDGES MD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-741-6408
Mailing Address - Street 1:8553 N BEACH ST
Mailing Address - Street 2:319
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4919
Mailing Address - Country:US
Mailing Address - Phone:817-290-2119
Mailing Address - Fax:817-549-0473
Practice Address - Street 1:425 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1022
Practice Address - Country:US
Practice Address - Phone:817-820-3400
Practice Address - Fax:817-820-3470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00981ROtherBCBS
TX156052601Medicaid
TX00981ROtherBCBS
TX00981RMedicare PIN
TX156052601Medicaid