Bridgeport Pharmacy, Inc

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

10657A Issued in MI

Legal business name

BRIDGEPORT PHARMACY, INC

Doing business as

Bridgeport Home Medical Supply

Practice address

6226 Dixie Hwy
Bridgeport, MI 48722-9513

Phone

(989) 777-3286

Fax

(989) 777-3384

NPI assigned

May 1, 2006

Last updated

Dec 10, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

BRIDGEPORT PHARMACY INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Karen Marie Boettcher

Title

Vice President

Phone

(989) 777-3286

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Bridgeport Home Medical Supply Doing business as

Part of

Bridgeport Pharmacy Inc

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Bridgeport Pharmacy Inc

  • Pharmacist
  • Bridgeport, MI
  • NPI 1114917242
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291939200000",
    "number": "1356308480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6226 DIXIE HWY",
            "city": "BRIDGEPORT",
            "state": "MI",
            "postal_code": "487229513",
            "telephone_number": "989-777-3286",
            "fax_number": "989-777-3384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6226 DIXIE HWY",
            "city": "BRIDGEPORT",
            "state": "MI",
            "postal_code": "487229513",
            "telephone_number": "989-777-3286",
            "fax_number": "989-777-3384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEPORT PHARMACY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRIDGEPORT PHARMACY INC",
        "enumeration_date": "2006-05-01",
        "last_updated": "2010-12-10",
        "status": "A",
        "authorized_official_last_name": "BOETTCHER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "989-777-3286",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "MI",
            "license": "10657A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0G30386",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4226131",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridgeport Home Medical Supply",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Customized Equipment (DME) in Bridgeport, MI
• Providers in Bridgeport, MI by specialty
• Customized Equipment (DME) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.