Healthcare Provider Details

I. General information

NPI: 1811508765
Provider Name (Legal Business Name): PW-HOSPITAL BRIDGE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HILL ST STE A
SPRINGFIELD TN
37172-2951
US

IV. Provider business mailing address

1000 URBAN CENTER DR STE 600
VESTAVIA AL
35242-2584
US

V. Phone/Fax

Practice location:
  • Phone: 615-382-3002
  • Fax: 615-953-9581
Mailing address:
  • Phone: 205-208-9312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA COX
Title or Position: CREDENTIALING
Credential:
Phone: 205-246-9312