| Bridgewell LLC | |
|
402 W Boughton Rd Ste A Bolingbrook IL 60440-1998 | |
| (312) 451-6148 | |
| Not Available |
| Full Name | Bridgewell LLC |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 402 W Boughton Rd Ste A, Bolingbrook, Illinois |
| Authorized Official Name and Position | Isoken Ogbomo (NURSE PRACTITIONER) |
| Authorized Official Contact | 3124516418 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgewell LLC 402 W Boughton Rd Ste A Bolingbrook IL 60440-1998 Ph: (312) 451-6148 | Bridgewell LLC 402 W Boughton Rd Ste A Bolingbrook IL 60440-1998 Ph: (312) 451-6148 |
| NPI Number | 1972296382 |
|---|---|
| Provider Enumeration Date | 05/31/2023 |
| Last Update Date | 09/01/2023 |
| Certification Date | 09/01/2023 |
| Medicare PECOS PAC ID | 3173986940 |
|---|---|
| Medicare Enrollment ID | O20230825002439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972296382 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (NU) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (NU) | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | (NU) | Primary |
| Provider Name | Rose O Ampadu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366997561 PECOS PAC ID: 9335436518 Enrollment ID: I20161003001799 |
| Provider Name | Isoken Franca Ogbomo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275049694 PECOS PAC ID: 7416367636 Enrollment ID: I20201029000888 |
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