Healthcare Provider Details

I. General information

NPI: 1700902244
Provider Name (Legal Business Name): BRIDGES MEDICAL SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 STATE HIGHWAY Y
FORSYTH MO
65653-5618
US

IV. Provider business mailing address

PO BOX 1240
FORSYTH MO
65653-1240
US

V. Phone/Fax

Practice location:
  • Phone: 417-546-4200
  • Fax: 417-546-4505
Mailing address:
  • Phone: 417-546-4200
  • Fax: 417-546-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANIECE RACHELLE BRIDGES
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 417-546-4200