Provider Demographics
NPI:1538437579
Name:CAP COD HOSPITAL
Entity type:Organization
Organization Name:CAP COD HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:RRA
Authorized Official - Phone:508-771-1800
Mailing Address - Street 1:27 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5230
Mailing Address - Country:US
Mailing Address - Phone:508-771-1800
Mailing Address - Fax:
Practice Address - Street 1:27 PARK ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5230
Practice Address - Country:US
Practice Address - Phone:508-771-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16172282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital