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NPI Code Detail

MEDICARE: BRIDGET UNDERWOOD BS CRIMINAL JUSTICE

MEDICARE: BRIDGET UNDERWOOD BS CRIMINAL JUSTICE
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1952263733
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIDGET UNDERWOOD BS CRIMINAL JUSTICE
Provider Business Mailing Address
First Line : 909 MORGANTOWN AVE
Second Line :
City : FAIRMONT
State : WV
Zip : 26554-4335
Country : US
Telephone Number : 304-871-2114
Fax Number :
Provider Business Practice Location Address
First Line : 909 MORGANTOWN AVE
Second Line :
City : FAIRMONT
State : WV
Zip : 26554-4335
Country : US
Telephone Number : 304-871-2114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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