Provider Demographics
NPI:1932377140
Name:THE BRIDGE MEDICAL SERVICE, LLC
Entity Type:Organization
Organization Name:THE BRIDGE MEDICAL SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-795-4409
Mailing Address - Street 1:PO BOX 17186
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-0186
Mailing Address - Country:US
Mailing Address - Phone:901-795-4409
Mailing Address - Fax:901-795-4403
Practice Address - Street 1:6073 MT MORIAH RD EXT
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2644
Practice Address - Country:US
Practice Address - Phone:901-795-4409
Practice Address - Fax:901-795-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1501628Medicaid