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General NPI Number Information
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NPI Number | 1124323597
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Entity Type | Organization
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Legal Business Name | CBM HEALTH CARE INC
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Dates
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Enumeration Date | 01/17/2011
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 14229 TORREY RD # 2
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City | FENTON
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State | MI
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Zip | 48430-3308
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Country | US
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Telephone | 313-815-8767
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Fax | 810-458-4187
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Provider Business Mailing Address
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Address Line | PO BOX 489
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City | LINDEN
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State | MI
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Zip | 48451-0489
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Country | US
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Telephone | 313-815-8767
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Fax | 810-458-4187
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Authorized Official
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Title or Position | COO/CFO
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Name | MS. JULIE A JERNIGAN
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Credential |
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Telephone | 734-347-1462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4301039079
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4307095750
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601004426
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4301089099
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License Number State | MI
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