1154609956 NPI number — CAPITAL CITY FAMILY PRACTICE,INC

Table of content: (NPI 1154609956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154609956 NPI number — CAPITAL CITY FAMILY PRACTICE,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL CITY FAMILY PRACTICE,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:
1154609956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3441 MARYSVILLE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95838-4512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-563-7230
Provider Business Mailing Address Fax Number:
916-563-7229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 CADILLAC DR STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-8328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-822-8998
Provider Business Practice Location Address Fax Number:
916-822-8984
Provider Enumeration Date:
07/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BLANKENSHIP
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
916-563-7230

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com