Healthcare Provider Details

I. General information

NPI: 1043078439
Provider Name (Legal Business Name): THE KAPTAIN CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8520 ALLISON POINTE BLVD STE 223 #52506
INDIANAPOLIS IN
46250
US

IV. Provider business mailing address

8520 ALLISON POINTE BLVD STE 223 #52506
INDIANAPOLIS IN
46250
US

V. Phone/Fax

Practice location:
  • Phone: 650-336-0650
  • Fax:
Mailing address:
  • Phone: 650-336-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES B HARRIS III
Title or Position: PRESIDENT
Credential: MD
Phone: 650-336-0650