Bridgeport Behavioral Clinic | |
527 Medical Park Dr Ste 105 Bridgeport WV 26330-9009 | |
(304) 933-3885 | |
(304) 933-3887 |
Full Name | Bridgeport Behavioral Clinic |
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Speciality | Psychiatry & Neurology |
Location | 527 Medical Park Dr Ste 105, Bridgeport, West Virginia |
Authorized Official Name and Position | Muhammad Salman (PRESIDENT) |
Authorized Official Contact | 3049333885 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Bridgeport Behavioral Clinic 527 Medical Park Dr Ste 105 Bridgeport WV 26330-9009 Ph: (304) 933-3885 | Bridgeport Behavioral Clinic 527 Medical Park Dr Ste 105 Bridgeport WV 26330-9009 Ph: (304) 933-3885 |
NPI Number | 1538388939 |
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Provider Enumeration Date | 04/24/2007 |
Last Update Date | 10/02/2022 |
Certification Date | 10/02/2022 |
Medicare PECOS PAC ID | 3375534639 |
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Medicare Enrollment ID | O20040524001209 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538388939 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | 19711 (West Virginia) | Primary |
Provider Name | Muhammad Salman |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1649326075 PECOS PAC ID: 4981695244 Enrollment ID: I20040525000765 |
Provider Name | Lesia D Gibson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275997686 PECOS PAC ID: 8325339047 Enrollment ID: I20180829000327 |
Provider Name | Leslie D. Mavromatis |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1922546175 PECOS PAC ID: 6901274836 Enrollment ID: I20221123002526 |
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