Provider Demographics
NPI:1750538476
Name:BRADEN RIVER INTERNAL MEDICINE ASSOCIATES LLC
Entity type:Organization
Organization Name:BRADEN RIVER INTERNAL MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LOMBOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-329-1329
Mailing Address - Street 1:PO BOX 405484
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5484
Mailing Address - Country:US
Mailing Address - Phone:941-238-0380
Mailing Address - Fax:941-238-0390
Practice Address - Street 1:8625 54TH DR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9456
Practice Address - Country:US
Practice Address - Phone:941-238-0380
Practice Address - Fax:941-238-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62800OtherBCBS OF FL
FL62800OtherBCBS OF FL