Provider Demographics
NPI:1699561985
Name:BRIDGE PLASTIC SURGERY, SKIN AND VEIN CENTER, PLLC
Entity type:Organization
Organization Name:BRIDGE PLASTIC SURGERY, SKIN AND VEIN CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-594-6217
Mailing Address - Street 1:2727 OLDHAM LN
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-6116
Mailing Address - Country:US
Mailing Address - Phone:319-594-6217
Mailing Address - Fax:
Practice Address - Street 1:4601 ANTILLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5914
Practice Address - Country:US
Practice Address - Phone:319-594-6217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty