1174856645 NPI number — LIFEBRIDGE INVESTMENTS

Table of content: (NPI 1174856645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174856645 NPI number — LIFEBRIDGE INVESTMENTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEBRIDGE INVESTMENTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LIFEBRIDGE COMMUNITY PRACTICES DBA CLINICAL ASSOCIATES SPECIALISTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174856645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 W BELVEDERE AVE
Provider Second Line Business Mailing Address:
CREDENTIALING
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21215-5216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-601-5523
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 301A
Provider Business Practice Location Address City Name:
REISTERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21136-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-526-3060
Provider Business Practice Location Address Fax Number:
410-526-3091
Provider Enumeration Date:
09/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
BEASLEY
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
410-494-1212

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA1490 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com