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General NPI Number Information
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NPI Number | 1013741420
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Entity Type | Organization
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Legal Business Name | CAREBRIDGE MEDTEAM, LLC
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 515 N 3RD ST
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City | LONGVIEW
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State | TX
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Zip | 75601-6546
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Country | US
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Telephone | 903-475-3474
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Fax |
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Provider Business Mailing Address
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Address Line | 515 N 3RD ST
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City | LONGVIEW
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State | TX
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Zip | 75601-6546
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Country | US
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Telephone | 903-475-3474
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Fax |
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Authorized Official
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Title or Position | CHIEF HUMAN RESOURCE OFFICE
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Name | LACHELLE GRIFFIN
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Credential |
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Telephone | 769-208-4437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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