Healthcare Provider Details

I. General information

NPI: 1639995061
Provider Name (Legal Business Name): BRIDGE PURCHASING SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 11TH AVE FL 3 STE
SEATTLE WA
98122
US

IV. Provider business mailing address

PO BOX 454
ROGERS AR
72757-0454
US

V. Phone/Fax

Practice location:
  • Phone: 888-253-5667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: DANI WAGNON
Title or Position: VP/GM
Credential:
Phone: 888-253-5667