Healthcare Provider Details

I. General information

NPI: 1194718312
Provider Name (Legal Business Name): CAPE COD ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 HERITAGE PARK
SANDWICH MA
02563
US

IV. Provider business mailing address

PO BOX 820 280 HERITAGE PARK
SANDWICH MA
02563-0820
US

V. Phone/Fax

Practice location:
  • Phone: 508-833-6050
  • Fax: 508-833-6029
Mailing address:
  • Phone: 508-833-6050
  • Fax: 508-833-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA J BRUN
Title or Position: ADMINISTRATOR
Credential:
Phone: 508-833-6050