Provider Demographics
NPI:1174129829
Name:BRIDGES PSYCHIATRY
Entity type:Organization
Organization Name:BRIDGES PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALOG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-339-1563
Mailing Address - Street 1:115 FAIRCHILD ST STE 170
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7602
Mailing Address - Country:US
Mailing Address - Phone:803-339-1563
Mailing Address - Fax:803-746-7902
Practice Address - Street 1:115 FAIRCHILD ST STE 170
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7602
Practice Address - Country:US
Practice Address - Phone:803-339-1563
Practice Address - Fax:803-746-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty