Provider Demographics
NPI:1275291361
Name:LIVING THE BREAMEDICAL - SALISBURY, PLLC
Entity Type:Organization
Organization Name:LIVING THE BREAMEDICAL - SALISBURY, PLLC
Other - Org Name:BREAM MEDICAL SALISBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:H
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-210-8409
Mailing Address - Street 1:721 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3339
Mailing Address - Country:US
Mailing Address - Phone:704-216-1263
Mailing Address - Fax:704-216-1693
Practice Address - Street 1:721 GROVE ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3339
Practice Address - Country:US
Practice Address - Phone:252-702-0267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty