Robert Bridge, MD
Individual provider Active NPI Emergency Medicine Physician · Glencoe, MO
NPI 1073621132 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1073621132
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- MD101261 (MO)
- Practice address
- 1524 Garden Valley Dr
Glencoe, MO 63038-1489 - Phone
- (636) 273-4418
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100818001364 | MO | Practitioner - Internal Medicine |
5597899039 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD101261 | MO | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Emergency Physicians of Memphis LLC | Emergency Medicine | Current |
Accepting new patients |
Locations
1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000
2305 Georgia St
Louisiana, MO 63353
Phone (573) 754-4584
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | MD101261 | MO | Yes |
Addresses
Primary practice location
1524 Garden Valley Dr
Glencoe, MO 63038-1489
Mailing address
1524 Garden Valley Dr
Glencoe, MO 63038-1489
Phone (636) 273-4418
Other providers in Glencoe, MO
All providers in Glencoe, MO · Emergency Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.