MEDICARE: CAREBRIDGE PRIMARY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457814337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREBRIDGE PRIMARY CARE

Provider Business Mailing Address
First Line	:	7625 CAMARGO RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45243-3107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7625 CAMARGO RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45243-3107
Country	:	US
Telephone Number	:	513-528-8150
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	ANGELA BOWMAN
Credential	:
Telephone Number	:	513-528-8779

Provider Enumeration Date	:	04/09/2019
Last Update Date	:	06/11/2019

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Directions to “CAREBRIDGE PRIMARY CARE ” Practice Location

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