MEDICARE: JOHN THOMAS BRIDGEST PA

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	363AM0700X	Medical Physician Assistant	PA01147	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TXB158726	OTHER	TX	WELLMED MEDICARE

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	:	1245237999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN THOMAS BRIDGEST PA

Provider Business Mailing Address
First Line	:	6157 NW LOOP 410
Second Line	:	STE. 124
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-3302
Country	:	US
Telephone Number	:	210-523-1411
Fax Number	:	210-523-9307

Provider Business Practice Location Address
First Line	:	6157 NW LOOP 410
Second Line	:	STE. 124
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-3302
Country	:	US
Telephone Number	:	210-523-1411
Fax Number	:	210-523-9307

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/18/2016

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Directions to “ JOHN THOMAS BRIDGEST PA” Practice Location

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