1194718312 NPI number — CAPE COD ASC LLC

Table of content: (NPI 1194718312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194718312 NPI number — CAPE COD ASC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPE COD ASC LLC
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:
1194718312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 820
Provider Second Line Business Mailing Address:
280 HERITAGE PARK
Provider Business Mailing Address City Name:
SANDWICH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02563-0820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-833-6050
Provider Business Mailing Address Fax Number:
508-833-6029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 HERITAGE PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDWICH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-833-6050
Provider Business Practice Location Address Fax Number:
508-833-6029
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRUN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
508-833-6050

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5453231 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6800018 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 505370 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: M77019 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1999325 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 806016 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2160646 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 903441 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".




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