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General NPI Number Information
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NPI Number | 1134675317
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Entity Type | Organization
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Legal Business Name | CAPERNAUM MEDICAL CENTER
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 5129 S LAKELAND DR UNIT 1 AND 2
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City | LAKELAND
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State | FL
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Zip | 33813-2598
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Country | US
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Telephone | 212-361-9408
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95448
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City | LAKELAND
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State | FL
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Zip | 33804-5448
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Country | US
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Telephone | 212-361-9408
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC R VERNIER
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Credential | MD
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Telephone | 212-361-9408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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