MEDICARE: BRIDGES DIALYSIS LLC

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

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	:	1093012544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGES DIALYSIS LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	ATT: L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-320-4514
Fax Number	:	866-594-9961

Provider Business Practice Location Address
First Line	:	1833 MAGNAVOX WAY
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1539
Country	:	US
Telephone Number	:	260-432-1036
Fax Number	:	260-432-2085

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JOHN D WINSTEL
Credential	:
Telephone Number	:	253-733-4501

Provider Enumeration Date	:	02/18/2011
Last Update Date	:	10/04/2022

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