Provider Demographics
NPI:1861950396
Name:BRIDGE WATER MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:BRIDGE WATER MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-222-0088
Mailing Address - Street 1:750 SALEM DRIVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:OWNESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:833-763-3377
Mailing Address - Fax:270-297-9152
Practice Address - Street 1:750 SALEM DRIVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:OWNESBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:833-763-3377
Practice Address - Fax:270-297-9152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies