1770688566 NPI number — CAPITAL HEALTH PLAN, INC,

Table of content: (NPI 1770688566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770688566 NPI number — CAPITAL HEALTH PLAN, INC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL HEALTH PLAN, 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:
CAPITAL GROUP HEALTH SERVICES OF FLORIDA, INC.
Provider Other Organization Name Type Code:
4
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:
1770688566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15349
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32317-5349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-383-3333
Provider Business Mailing Address Fax Number:
850-383-3441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2140 CENTERVILLE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-383-3333
Provider Business Practice Location Address Fax Number:
850-383-3497
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAWEK
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
850-383-3427

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  03- , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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