Provider Demographics
NPI:1194706051
Name:ALPHA BRIDGE CONNECTIONS, LLC
Entity type:Organization
Organization Name:ALPHA BRIDGE CONNECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-558-6561
Mailing Address - Street 1:10150 HIGHLAND MANOR DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9712
Mailing Address - Country:US
Mailing Address - Phone:813-558-6500
Mailing Address - Fax:813-558-6572
Practice Address - Street 1:10150 HIGHLAND MANOR DR
Practice Address - Street 2:SUITE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9712
Practice Address - Country:US
Practice Address - Phone:813-558-6500
Practice Address - Fax:813-558-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007530458OtherAETNA
FL266544100Medicaid
FL34616OtherBLUE CROSS BLUE SHIELD
MN038U0ALOtherBLUE CROSS BLUE SHIELD MN
001500049OtherHIGHMARK BCBS
CK4226OtherUNITED AMERICAN
CK8272OtherRAILROAD MEDICARE
FL34616OtherBLUE CROSS BLUE SHIELD
CK4226OtherUNITED AMERICAN
=========33637A001OtherTRICARE
K4226Medicare ID - Type Unspecified