| Charlie H Bridges Md, Facs | |
| 
					7777 Hennessy Blvd Ste 608 Baton Rouge LA 70808-4366  | |
| (225) 767-0394 | |
| (225) 767-3904 | 
| Full Name | Charlie H Bridges Md, Facs | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 7777 Hennessy Blvd Ste 608, Baton Rouge, Louisiana | 
| Authorized Official Name and Position | Charlie H Bridges (OWNER) | 
| Authorized Official Contact | 2257670394 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Charlie H Bridges Md, Facs 7777 Hennessy Blvd Ste 608 Baton Rouge LA 70808-4366 Ph: (225) 767-0394  | Charlie H Bridges Md, Facs 7777 Hennessy Blvd Ste 608 Baton Rouge LA 70808-4366 Ph: (225) 767-0394  | 
| NPI Number | 1003135633 | 
|---|---|
| Provider Enumeration Date | 05/21/2010 | 
| Last Update Date | 06/12/2014 | 
| Medicare PECOS PAC ID | 0143351577 | 
|---|---|
| Medicare Enrollment ID | O20100629000838 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1003135633 | NPI | - | NPPES | 
| 1370339 | Medicaid | LA | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261Q00000X | Clinic/center | 07141R (Louisiana) | Primary | 
| Provider Name | Charlie H Bridges | 
|---|---|
| Provider Type | Practitioner - Urology | 
| Provider Identifiers | NPI Number: 1457386310 PECOS PAC ID: 8123159555 Enrollment ID: I20100629000867  | 
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