Provider Demographics
NPI:1770130940
Name:ONE BRIDGE SURGICAL, PLLC
Entity type:Organization
Organization Name:ONE BRIDGE SURGICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TSENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-322-2324
Mailing Address - Street 1:1972 MESQUITE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5729
Mailing Address - Country:US
Mailing Address - Phone:928-854-6500
Mailing Address - Fax:928-854-6206
Practice Address - Street 1:1972 MESQUITE AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5729
Practice Address - Country:US
Practice Address - Phone:928-854-6500
Practice Address - Fax:928-854-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23008764OtherCORPORATION ID NUMBER