Provider Demographics
NPI:1346430469
Name:CABALLERO FAMILY HEALTHCARE GROUP PLLC
Entity Type:Organization
Organization Name:CABALLERO FAMILY HEALTHCARE GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-751-9997
Mailing Address - Street 1:1920 KIRBY PKWY
Mailing Address - Street 2:#202
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3696
Mailing Address - Country:US
Mailing Address - Phone:901-751-9997
Mailing Address - Fax:901-751-1344
Practice Address - Street 1:1920 KIRBY PKWY
Practice Address - Street 2:#202
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3696
Practice Address - Country:US
Practice Address - Phone:901-751-9997
Practice Address - Fax:901-751-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000020966208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE68144Medicare UPIN
TN3706606Medicare PIN
TN3056400Medicare PIN