Provider Demographics
NPI:1831791664
Name:BRIDGEMD LLC
Entity type:Organization
Organization Name:BRIDGEMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMBINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-234-9746
Mailing Address - Street 1:16391 76TH TRL N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7671
Mailing Address - Country:US
Mailing Address - Phone:408-234-9746
Mailing Address - Fax:
Practice Address - Street 1:16391 76TH TRL N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418-7671
Practice Address - Country:US
Practice Address - Phone:561-293-4893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGE MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care