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General NPI Number Information
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NPI Number | 1396383196
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY INTEGRATED HEALTHCARE SERVICES
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 6013 S REDWOOD RD
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-5220
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Country | US
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Telephone | 801-255-5131
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Fax |
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Provider Business Mailing Address
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Address Line | 6011 S REDWOOD RD
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-5220
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Country | US
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Telephone | 801-255-5131
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NATALIE WHATCOTT
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Credential |
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Telephone | 801-255-5131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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