| Bridgewater Medical Center | |
|
230 Madison Square Dr Ste C Madisonville KY 42431-2792 | |
| (270) 821-6262 | |
| (270) 821-6272 |
| Full Name | Bridgewater Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 230 Madison Square Dr Ste C, Madisonville, Kentucky |
| Authorized Official Name and Position | Jamie Daniel (ADMINISTRATOR) |
| Authorized Official Contact | 2708216262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgewater Medical Center 230 Madison Square Dr Ste C Madisonville KY 42431-2792 Ph: (270) 821-6262 | Bridgewater Medical Center 230 Madison Square Dr Ste C Madisonville KY 42431-2792 Ph: (270) 821-6262 |
| NPI Number | 1962639187 |
|---|---|
| Provider Enumeration Date | 06/15/2009 |
| Last Update Date | 08/06/2020 |
| Medicare PECOS PAC ID | 5193865624 |
|---|---|
| Medicare Enrollment ID | O20100526000074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962639187 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 42115 (Kentucky) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Jayna R Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760662373 PECOS PAC ID: 9931013927 Enrollment ID: I20080506000775 |
| Provider Name | Michael B Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144497538 PECOS PAC ID: 5395809156 Enrollment ID: I20090123000208 |
| Provider Name | Holly Cardwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467909994 PECOS PAC ID: 4486932449 Enrollment ID: I20161025002893 |
| Provider Name | Tammy Barre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720617285 PECOS PAC ID: 8022449479 Enrollment ID: I20200519001014 |
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