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General NPI Number Information
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NPI Number | 1376967380
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Entity Type | Organization
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Legal Business Name | NEWBRIDGE MEDICAL GROUP LLC
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 1801 LEE RD STE 175
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City | WINTER PARK
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State | FL
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Zip | 32789-2167
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Country | US
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Telephone | 407-644-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 LEE RD STE 115
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City | WINTER PARK
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State | FL
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Zip | 32789-2163
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ARTHUR WRIGHT
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Credential |
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Telephone | 407-644-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 800028600
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License Number State | FL
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