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General NPI Number Information
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NPI Number | 1861950396
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Entity Type | Organization
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Legal Business Name | BRIDGE WATER MEDICAL EQUIPMENT
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 03/04/2019
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Provider Practice Location Address
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Address Line | 750 SALEM DRIVE SUITE 2B
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City | OWNESBORO
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State | KY
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Zip | 42303
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Country | US
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Telephone | 833-763-3377
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Fax | 270-297-9152
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Provider Business Mailing Address
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Address Line | 750 SALEM DRIVE SUITE 2B
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City | OWNESBORO
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State | KY
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Zip | 42303
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Country | US
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Telephone | 833-763-3377
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Fax | 270-297-9152
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Authorized Official
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Title or Position | OWNER
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Name | JAYNA JONES
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Credential | MD
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Telephone | 270-222-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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