MEDICARE: BRIDGET'S SURGICAL FIRST ASSIST

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	163WR0006X	Registered Nurse First Assistant	0992518	CO

General Provider Information

NPI Number	:	1356890735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGET'S SURGICAL FIRST ASSIST

Provider Business Mailing Address
First Line	:	1815 CENTRAL PARK DR
Second Line	:	STE 110 PMB 231
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8885
Country	:	US
Telephone Number	:	610-945-7281
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 CENTRAL PARK DR
Second Line	:	STE 110 PMB 231
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8885
Country	:	US
Telephone Number	:	610-945-7281
Fax Number	:

Authorized Official
Title or Position	:	NP
Name	:	BRIDGET SEIDEL
Credential	:
Telephone Number	:	610-945-7281

Provider Enumeration Date	:	09/27/2016
Last Update Date	:	09/27/2016

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