MEDICARE: HEALTH BRIDGES MEDICAL CENTER

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	207Q00000X	Family Medicine Physician	CH5495	FL

General Provider Information

NPI Number	:	1699055376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH BRIDGES MEDICAL CENTER

Provider Business Mailing Address
First Line	:	4380 CLEVELAND AVE
Second Line	:	C3
City	:	FORT MYERS
State	:	FL
Zip	:	33901
Country	:	US
Telephone Number	:	239-438-5330
Fax Number	:

Provider Business Practice Location Address
First Line	:	4380 CLEVELAND AVE
Second Line	:	C3
City	:	FORT MYERS
State	:	FL
Zip	:	33901
Country	:	US
Telephone Number	:	239-438-5330
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	MS. ALEXANDRA BROWN
Credential	:
Telephone Number	:	239-438-5330

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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