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General NPI Number Information
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NPI Number | 1609510809
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY CLINICS LLC
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Dates
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Enumeration Date | 04/24/2022
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 4429 S RIVER BLVD
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City | INDEPENDENCE
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State | MO
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Zip | 64055-4659
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Country | US
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Telephone | 816-786-4253
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Fax |
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Provider Business Mailing Address
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Address Line | 4429 S RIVER BLVD
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City | INDEPENDENCE
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State | MO
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Zip | 64055-4659
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Country | US
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Telephone | 816-786-4253
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | SHEILA HALE
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Credential |
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Telephone | 816-786-4253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry 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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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