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General NPI Number Information
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NPI Number | 1356227805
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Entity Type | Organization
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Legal Business Name | NORTHBRIDGE MEDICAL 1 DBA
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 4025 E SOUTHCROSS BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78222-3641
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Country | US
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Telephone | 210-251-4846
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Fax |
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Provider Business Mailing Address
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Address Line | 4025 E SOUTHCROSS BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78222-3641
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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 | OWNER
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Name | CALEB BISHOP
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Credential |
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Telephone | 210-251-4846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional 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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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