| Bridge Utah Medical Group | |
|
1015 E 100 N Logan UT 84321-4873 | |
| (888) 221-0423 | |
| (888) 221-9816 |
| Full Name | Bridge Utah Medical Group |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 1015 E 100 N, Logan, Utah |
| Authorized Official Name and Position | Cameron G Peterson (CHIEF MEDICAL OFFICER, MANAGING PAR) |
| Authorized Official Contact | 8015988337 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Utah Medical Group Po Box 1468 Bountiful UT 84011-1468 Ph: (888) 853-8973 | Bridge Utah Medical Group 1015 E 100 N Logan UT 84321-4873 Ph: (888) 221-0423 |
| NPI Number | 1104324904 |
|---|---|
| Provider Enumeration Date | 01/26/2018 |
| Last Update Date | 03/14/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104324904 | NPI | - | NPPES |
| 0000 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
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