# BRIDGEPORT EXPRESS CARE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912142001
- **Authorized official:** TIMOTHY PEASAK DO (PRESIDENT)
- **Authorized official phone:** (304) 842-3330

## Contact information

- **Practice address:** 1370 JOHNSON AVE FL 1, BRIDGEPORT, WV 26330-1492
- **Practice address phone:** (304) 842-3330
- **Practice address fax:** (304) 842-3303
- **Mailing address:** 1370 JOHNSON AVE FL 1, BRIDGEPORT, WV 26330-1492
- **Mailing address phone:** (304) 842-3330
- **Mailing address fax:** (304) 842-3303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/04/2008
- **Last updated:** 01/03/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3810013952 | — | WV |