Healthcare Provider Details

I. General information

NPI: 1568935278
Provider Name (Legal Business Name): BRIDGE CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6357 ROCKVILLE RD
INDIANAPOLIS IN
46214-3920
US

IV. Provider business mailing address

6357 ROCKVILLE RD
INDIANAPOLIS IN
46214-3920
US

V. Phone/Fax

Practice location:
  • Phone: 317-757-2563
  • Fax: 317-405-9970
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LATIFAT A. OYEKOLA
Title or Position: OWNER
Credential: MD
Phone: 317-495-5173