Provider Demographics
NPI:1972620383
Name:BRIDGES MEDICAL SERVICES P.C.
Entity type:Organization
Organization Name:BRIDGES MEDICAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANIECE
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-546-4200
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MO
Mailing Address - Zip Code:65653-1240
Mailing Address - Country:US
Mailing Address - Phone:417-546-4200
Mailing Address - Fax:417-546-4505
Practice Address - Street 1:155 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MO
Practice Address - Zip Code:65753
Practice Address - Country:US
Practice Address - Phone:417-634-4203
Practice Address - Fax:417-634-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO595903410Medicaid
MO595903410Medicaid
MO000013095Medicare PIN