Provider Demographics
NPI:1093203291
Name:CLIMB MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:CLIMB MEDICAL GROUP LLC
Other - Org Name:CLIMB INNOVATIONS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO OF CLIMB MEDICAL GROUP LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-644-3118
Mailing Address - Street 1:1131 TOLLAND TPKE # 129-O
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1679
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:828 SULLIVAN AVE STE A
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074
Practice Address - Country:US
Practice Address - Phone:860-327-5140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 103TA0400X, 207Q00000X
CT53445207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1942592514OtherMY PERSONAL NPI NUMBER
CT1396193488OtherPRIOR NPI FOR PRIOR LEGAL NAME (CLIMB INNOVATIONS LLC)
CT1093203291OtherGROUP NPI FOR CLIMB MEDICAL GROUP LLC