| Life Bridges, Inc | |
|
764 Old Chattanooga Pk. Cleveland TN 37311 | |
| (423) 472-5268 | |
| (423) 479-1492 |
| Full Name | Life Bridges, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 764 Old Chattanooga Pk., Cleveland, Tennessee |
| Authorized Official Name and Position | Diana Jackson (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4234725268 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Bridges, Inc Po Box 29 Cleveland TN 37364-0029 Ph: (423) 472-5268 | Life Bridges, Inc 764 Old Chattanooga Pk. Cleveland TN 37311 Ph: (423) 472-5268 |
| NPI Number | 1700928876 |
|---|---|
| Provider Enumeration Date | 02/13/2007 |
| Last Update Date | 10/05/2017 |
| Medicare PECOS PAC ID | 8628147410 |
|---|---|
| Medicare Enrollment ID | O20080520000387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700928876 | NPI | - | NPPES |
| Provider Name | Troy D Gilson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275621252 PECOS PAC ID: 2769463439 Enrollment ID: I20040527001113 |
| Provider Name | Roni A Rawls |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1962670851 PECOS PAC ID: 5799862728 Enrollment ID: I20080401000768 |
| Provider Name | Cecil Dewayne Knight |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1508909599 PECOS PAC ID: 7214016021 Enrollment ID: I20080523000465 |
| Provider Name | David Cobb |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1780843862 PECOS PAC ID: 2264572197 Enrollment ID: I20091228000082 |
| Provider Name | Joe Michael Mazzolini |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811908718 PECOS PAC ID: 5092606897 Enrollment ID: I20100922000924 |
| Provider Name | Lisa Copeland |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1124234984 PECOS PAC ID: 3971839796 Enrollment ID: I20190731001445 |
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