MEDICARE: CAPITAL MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center		NC

General Provider Information

NPI Number	:	1700908647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL MEDICAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 41213
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27629-1213
Country	:	US
Telephone Number	:	919-878-3655
Fax Number	:	919-878-3647

Provider Business Practice Location Address
First Line	:	3509 CAPITAL BLVD
Second Line	:	SUITE 101
City	:	RALEIGH
State	:	NC
Zip	:	27604-3325
Country	:	US
Telephone Number	:	919-878-3655
Fax Number	:	919-878-3647

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. RUTH WATKINS
Credential	:
Telephone Number	:	919-878-3655

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/21/2022

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Directions to “CAPITAL MEDICAL GROUP ” Practice Location

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