Healthcare Provider Details

I. General information

NPI: 1760333769
Provider Name (Legal Business Name): CBMB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9085 SANDIDGE CENTER CV STE 200
OLIVE BRANCH MS
38654-3577
US

IV. Provider business mailing address

14535 TREELINE DR
OLIVE BRANCH MS
38654-6327
US

V. Phone/Fax

Practice location:
  • Phone: 662-782-0660
  • Fax:
Mailing address:
  • Phone: 901-831-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY J CAIL
Title or Position: OWNER
Credential:
Phone: 901-831-5698