MEDICARE: BRIAN BRIDGES CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management		SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043565666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN BRIDGES CPO

Provider Business Mailing Address
First Line	:	1113 N FANT ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4819
Country	:	US
Telephone Number	:	864-225-1683
Fax Number	:

Provider Business Practice Location Address
First Line	:	1113 N FANT ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4819
Country	:	US
Telephone Number	:	864-225-1683
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	07/19/2012

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