Provider Demographics
NPI:1124323597
Name:CBM HEALTH CARE INC
Entity type:Organization
Organization Name:CBM HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-347-1462
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-0489
Mailing Address - Country:US
Mailing Address - Phone:313-815-8767
Mailing Address - Fax:810-458-4187
Practice Address - Street 1:14229 TORREY RD # 2
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3308
Practice Address - Country:US
Practice Address - Phone:313-815-8767
Practice Address - Fax:810-458-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039079261QP2300X
MI4307095750261QP2300X
MI5601004426363A00000X
MI4301089099261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherMEDICAID/MEDICARE #S PENDING