Provider Demographics
NPI:1841608114
Name:SUBLIME MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:SUBLIME MEDICAL GROUP PLLC
Other - Org Name:APEX INTEGRATIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-323-0236
Mailing Address - Street 1:805 WASHINGTON DR STE F
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-2528
Mailing Address - Country:US
Mailing Address - Phone:817-459-0220
Mailing Address - Fax:817-704-0108
Practice Address - Street 1:805 WASHINGTON DR STE F
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2528
Practice Address - Country:US
Practice Address - Phone:817-459-0220
Practice Address - Fax:817-704-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX846104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX846104Medicaid
TX846104Medicaid