Organization
BRIDGEWAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JOE HAYES (CASE MANAGER)
(620) 660-5191
Entity
Organization
Contact information
Practice address
620 W GRAND AVE, PONCA CITY, OK 74601-5123
(580) 762-1462
Mailing address
PO BOX 883, PONCA CITY, OK 74602-0883
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
B.S. PSYCHOLOGY
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200129920
—
OK
Enumeration date
06/13/2013
Last updated
06/24/2013
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