Provider Demographics
NPI:1740042480
Name:BRIDGING THE GAP COMMUNITY HEALTH CARE CLINIC L.L.C.
Entity type:Organization
Organization Name:BRIDGING THE GAP COMMUNITY HEALTH CARE CLINIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:314-226-3105
Mailing Address - Street 1:1120 S 6TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-3602
Mailing Address - Country:US
Mailing Address - Phone:573-723-6023
Mailing Address - Fax:573-273-3442
Practice Address - Street 1:1120 S 6TH ST STE 110
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-3602
Practice Address - Country:US
Practice Address - Phone:573-723-6023
Practice Address - Fax:573-273-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care