1326049651 NPI number — UPPER CAPE OPHTHAMOLOGY INC

Table of content: (NPI 1326049651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326049651 NPI number — UPPER CAPE OPHTHAMOLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPPER CAPE OPHTHAMOLOGY INC
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:
1326049651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 BRAMBLEBUSH PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02540-2325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-540-0511
Provider Business Mailing Address Fax Number:
508-540-5186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 BROTHER GEENEN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34236-7102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-556-3220
Provider Business Practice Location Address Fax Number:
941-955-8214
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOSLEE
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
508-540-0511

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  27269 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CB5951 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9746269 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000013337 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M14222 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 701408 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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