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General NPI Number Information
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NPI Number | 1093203291
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Entity Type | Organization
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Legal Business Name | CLIMB MEDICAL GROUP LLC
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 828 SULLIVAN AVE STE A
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074
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Country | US
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Telephone | 860-327-5140
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Fax |
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Provider Business Mailing Address
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Address Line | 1131 TOLLAND TPKE # 129-O
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City | MANCHESTER
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State | CT
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Zip | 06042-1679
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO OF CLIMB MEDICAL GROUP LLC
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Name | DR. CHAD MCDONALD
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Credential | DO
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Telephone | 860-644-3118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 53445
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License Number State | CT
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