MEDICARE: BRIDGE CLINICS BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1326661836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE CLINICS BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	6357 ROCKVILLE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-3920
Country	:	US
Telephone Number	:	317-757-2563
Fax Number	:	317-405-9970

Provider Business Practice Location Address
First Line	:	3702 E 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-2554
Country	:	US
Telephone Number	:	317-757-2563
Fax Number	:	317-405-9970

Authorized Official
Title or Position	:	OWNER
Name	:	LATIFAT A. OYEKOLA
Credential	:	MD
Telephone Number	:	317-495-5173

Provider Enumeration Date	:	05/19/2020
Last Update Date	:	06/04/2026

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