| Bridgeside Telehealth | |
|
2009 Tremont Ave Fort Worth TX 76107-3959 | |
| (817) 395-6284 | |
| Not Available |
| Full Name | Bridgeside Telehealth |
|---|---|
| Speciality | Clinic/Center |
| Location | 2009 Tremont Ave, Fort Worth, Texas |
| Authorized Official Name and Position | Susan Braddock (CEO) |
| Authorized Official Contact | 8173956284 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeside Telehealth 2009 Tremont Ave Fort Worth TX 76107-3959 Ph: () - | Bridgeside Telehealth 2009 Tremont Ave Fort Worth TX 76107-3959 Ph: (817) 395-6284 |
| NPI Number | 1861153785 |
|---|---|
| Provider Enumeration Date | 01/03/2022 |
| Last Update Date | 01/28/2022 |
| Medicare PECOS PAC ID | 7012300486 |
|---|---|
| Medicare Enrollment ID | O20220207002060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861153785 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Christina Ennabi Waller |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558789834 PECOS PAC ID: 8527336106 Enrollment ID: I20170623000238 |
| Provider Name | James Reichman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952864084 PECOS PAC ID: 6103252556 Enrollment ID: I20200414002996 |
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