Provider Demographics
NPI:1396193488
Name:CLIMB INNOVATIONS LLC
Entity Type:Organization
Organization Name:CLIMB INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:860-281-1614
Mailing Address - Street 1:51 STONEFIELD TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1715
Mailing Address - Country:US
Mailing Address - Phone:860-281-1614
Mailing Address - Fax:
Practice Address - Street 1:925 SULLIVAN AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2025
Practice Address - Country:US
Practice Address - Phone:860-432-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-30
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008066508Medicaid
CT008066508Medicaid