Provider Demographics
NPI:1881601995
Name:CLINICCARE LLC
Entity type:Organization
Organization Name:CLINICCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRECEPTOR-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-451-6296
Mailing Address - Street 1:575 E BLEDSOE ST
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3054
Mailing Address - Country:US
Mailing Address - Phone:615-451-6296
Mailing Address - Fax:615-451-6297
Practice Address - Street 1:575 E BLEDSOE ST
Practice Address - Street 2:SUITE 6B
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3054
Practice Address - Country:US
Practice Address - Phone:615-451-6296
Practice Address - Fax:615-451-6297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD24133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty