| Bridgeway Health Services, Llc | |
|
1032 S Bridge Way Pl Ste 110 Eagle ID 83616-6099 | |
| (208) 475-0800 | |
| Not Available |
| Full Name | Bridgeway Health Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1032 S Bridge Way Pl Ste 110, Eagle, Idaho |
| Authorized Official Name and Position | Stephanie Cheney (BUSINESS MANAGER) |
| Authorized Official Contact | 2084750800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeway Health Services, Llc 1032 S Bridge Way Pl Ste 110 Eagle ID 83616-6099 Ph: (208) 475-0800 | Bridgeway Health Services, Llc 1032 S Bridge Way Pl Ste 110 Eagle ID 83616-6099 Ph: (208) 475-0800 |
| NPI Number | 1619231784 |
|---|---|
| Provider Enumeration Date | 07/03/2012 |
| Last Update Date | 07/03/2012 |
| Medicare PECOS PAC ID | 0244462745 |
|---|---|
| Medicare Enrollment ID | O20140416001052 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619231784 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | M7357 (Idaho) | Primary |
| Provider Name | Grant Bennett Belnap |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356481790 PECOS PAC ID: 5890789127 Enrollment ID: I20040412000197 |
| Provider Name | Leslie S Kelly-majors |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619128931 PECOS PAC ID: 0648453290 Enrollment ID: I20110321000303 |
| Provider Name | Michael A Dickson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114107042 PECOS PAC ID: 0345423612 Enrollment ID: I20110323000824 |
| Provider Name | Steven C Ayers |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225425754 PECOS PAC ID: 1658669510 Enrollment ID: I20200923002478 |
| Provider Name | Keylee J Norman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760195978 PECOS PAC ID: 7911364773 Enrollment ID: I20230609000540 |
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