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General NPI Number Information
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NPI Number | 1245017821
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Entity Type | Organization
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Legal Business Name | CLINNEXUS INC.
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 610 S MAIN ST PH 107
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City | LOS ANGELES
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State | CA
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Zip | 90014-2040
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Country | US
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Telephone | 503-807-1123
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 840
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City | KITTERY POINT
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State | ME
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Zip | 03905
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Country | US
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Telephone | 503-807-1123
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. GREGORY CARROLL
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Credential | MD
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Telephone | 503-807-1123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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