1124112198 NPI number — CAPE CHARLES MEDICAL CENTER

Table of content: (NPI 1124112198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124112198 NPI number — CAPE CHARLES MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPE CHARLES MEDICAL CENTER
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:
Provider Other Organization Name Type Code:
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:
1124112198
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 MASON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CHARLES
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23310-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 MASON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE CHARLES
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23310-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-331-1422
Provider Business Practice Location Address Fax Number:
757-331-1624
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLARKE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
GREGORY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-331-1422

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101038467 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 454260 . This is a "ANTHEM GROUP #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C08218 . This is a "MEDICARE GROUP PTAN NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 005642434 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005642451 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ8918 . This is a "GROUP#" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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