Provider Demographics
NPI:1134700859
Name:CAREBRIDGE MEDICAL GROUP
Entity Type:Organization
Organization Name:CAREBRIDGE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:SHAW
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-585-1181
Mailing Address - Street 1:926 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3614
Mailing Address - Country:US
Mailing Address - Phone:615-436-9060
Mailing Address - Fax:
Practice Address - Street 1:101 HUDSON ST FL 21
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3929
Practice Address - Country:US
Practice Address - Phone:615-436-9060
Practice Address - Fax:615-235-9725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAREBRIDGE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-15
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty