=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780760777
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPE LOOKOUT MEDICAL SERV
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2006
-----------------------------------------------------
Last Update Date | 02/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106D PROFESSIONAL PARK DRIVE
-----------------------------------------------------
City | BEAUFORT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28516-2418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-728-5003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106D PROFESSIONAL PARK DR
-----------------------------------------------------
City | BEAUFORT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28516-2464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-728-5003
-----------------------------------------------------
Fax | 252-728-3841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PETER KUERS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 252-728-5003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------