Provider Demographics
NPI:1457998486
Name:BRIDGES CLINIC LLC
Entity Type:Organization
Organization Name:BRIDGES CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:769-200-1600
Mailing Address - Street 1:920 EBENEZER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6005
Mailing Address - Country:US
Mailing Address - Phone:769-200-1600
Mailing Address - Fax:769-200-1571
Practice Address - Street 1:920 EBENEZER BLVD STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6005
Practice Address - Country:US
Practice Address - Phone:769-200-1600
Practice Address - Fax:769-200-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty