Bridgeway Inc
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Pekin, IL
NPI 1346524899 · NPPES record last updated Jul 25, 2022
Key facts
- NPI
- 1346524899
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- BRIDGEWAY INC
- Practice address
- 2079 Edgewater Dr
Pekin, IL 61554 - Phone
- (309) 382-2006
- Fax
- (309) 382-2007
- NPI assigned
- Oct 3, 2011
- Organization subpart
- No
Authorized official
- Name
- William Nelson
- Title
- Ceo
- Phone
- (309) 344-2323
Other NPIs on the same Medicare enrollment 15
Practitioners 11
-
Tina I Crawford, RN
-
Debra Mollie Davis, RN BSN
-
Zabrin Inan, M.D.
-
Valerie Sze-Lynn Leong, M.D.
-
Richard McCoy, RN
-
William Wyatt Wood, M.D.
-
Renee Cook, D.O.
-
Claudia A Kachigian, M.D.
-
Todd K Pogue, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050126000609 | IL | Part B Supplier - Clinic/Group Practice | 4284627530 |
Receives reassigned benefits from 9 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Macomb, IL; Moline, IL; Monmouth, IL; Normal, IL; North Pekin, IL; Pekin, IL; Kewanee, IL; Loves Park, IL… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 04016 | IL | |
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
2079 Edgewater Dr
Pekin, IL 61554
Mailing address
2079 Edgewater Dr
Pekin, IL 61554-7833
Phone (309) 382-2006
Other practice location 1
2079 Edgewater Dr
Pekin, IL 61554
Phone (309) 382-2006
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AC 217/557-9285 | Other | IL | MEDICARE CERTIFICATION |
| 04016 | Medicaid | IL |
Other providers in Pekin, IL
- Joe L Bran
- Vicki R. Bree
- Brendon J Johnson, OD, PC
- Krystal Brent
- Regina Mae Tinio Kabatay Brian
- Kylanne Briggs
- Emily Irene Brown
- Kara Kathleen Brown
- Chelsea L Brush
- James Arthur Budds
All providers in Pekin, IL · Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.