MEDICARE: BRIDGE MEDICAL GROUP 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1972856631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	4303 N CENTRAL EXPY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-5597
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4303 N CENTRAL EXPY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-5597
Country	:	US
Telephone Number	:	214-534-9325
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	CARL WEINKAUF
Credential	:
Telephone Number	:	214-534-9325

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	10/18/2012

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Directions to “BRIDGE MEDICAL GROUP LLC ” Practice Location

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