| Bridgeport Behavioral Clinic | |
|
527 Medical Park Dr Ste 105 Bridgeport WV 26330-9009 | |
| (304) 933-3885 | |
| (304) 933-3887 |
| Full Name | Bridgeport Behavioral Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 527 Medical Park Dr Ste 105, Bridgeport, West Virginia |
| Authorized Official Name and Position | Muhammad Salman (PRESIDENT) |
| Authorized Official Contact | 3049333885 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeport Behavioral Clinic 527 Medical Park Dr Ste 105 Bridgeport WV 26330-9009 Ph: (304) 933-3885 | Bridgeport Behavioral Clinic 527 Medical Park Dr Ste 105 Bridgeport WV 26330-9009 Ph: (304) 933-3885 |
| NPI Number | 1538388939 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 10/02/2022 |
| Certification Date | 10/02/2022 |
| Medicare PECOS PAC ID | 3375534639 |
|---|---|
| Medicare Enrollment ID | O20040524001209 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538388939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 19711 (West Virginia) | Primary |
| Provider Name | Muhammad Salman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649326075 PECOS PAC ID: 4981695244 Enrollment ID: I20040525000765 |
| Provider Name | Lesia D Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275997686 PECOS PAC ID: 8325339047 Enrollment ID: I20180829000327 |
| Provider Name | Jennifer April Howard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336639947 PECOS PAC ID: 5597015313 Enrollment ID: I20180829000477 |
| Provider Name | Leslie D. Mavromatis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922546175 PECOS PAC ID: 6901274836 Enrollment ID: I20221123002526 |
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