1699950659 NPI number — CAPE COD INTERNAL MEDICINE

Table of content: (NPI 1699950659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699950659 NPI number — CAPE COD INTERNAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPE COD INTERNAL MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CAPE CAOD INTERNAL MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699950659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 CEDAR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYANNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02601-3009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-778-6363
Provider Business Mailing Address Fax Number:
508-778-6677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 CEDAR STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYANNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-778-6363
Provider Business Practice Location Address Fax Number:
508-778-6677
Provider Enumeration Date:
01/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ZENGER
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
508-778-6363

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6169295 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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