Healthcare Provider Details

I. General information

NPI: 1699508291
Provider Name (Legal Business Name): BRIDGEWAY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 WINDISH DR
GALESBURG IL
61401-9780
US

IV. Provider business mailing address

2323 WINDISH DR
GALESBURG IL
61401-9780
US

V. Phone/Fax

Practice location:
  • Phone: 309-344-2323
  • Fax: 309-344-4368
Mailing address:
  • Phone: 309-344-2323
  • Fax: 309-344-4368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE PHILLIPS
Title or Position: BILLING/COLLECTIONS SPECIALIST
Credential:
Phone: 309-342-4242