Healthcare Provider Details

I. General information

NPI: 1093769101
Provider Name (Legal Business Name): CAPE COD ORTHOPEDICS AND SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 NORTH ST
HYANNIS MA
02601-3825
US

IV. Provider business mailing address

18 ROUTE 6A
SANDWICH MA
02563-2019
US

V. Phone/Fax

Practice location:
  • Phone: 508-775-8282
  • Fax: 508-775-1414
Mailing address:
  • Phone: 508-775-8282
  • Fax: 508-775-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN A WILLIS
Title or Position: CEO
Credential: MD
Phone: 508-778-9336