Organization
BRIDGEWAY CENTER INC
Active
Organization
BRIDGEWAY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLAYTON RANDALL MCALLISTER MBA (CHIEF FINANCIAL OFFICER)
(850) 634-0050
Entity
Organization
Contact information
Practice address
137 HOSPITAL DRIVE, FORT WALTON BEACH, FL 32548
(850) 833-7512
(850) 833-7434
Mailing address
137 HOSPITAL DR NE, FORT WALTON BEACH, FL 32548-5063
(850) 833-7500
(850) 833-7443
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
26039072238
FL
208D00000X
General Practice Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060398823
—
FL
Enumeration date
08/19/2006
Last updated
08/13/2024
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