Provider Demographics
NPI:1730346115
Name:CAP MEDICAL, LLC
Entity type:Organization
Organization Name:CAP MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:AMIDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:315-225-3534
Mailing Address - Street 1:PO BOX 4272
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13442-4272
Mailing Address - Country:US
Mailing Address - Phone:315-225-3534
Mailing Address - Fax:
Practice Address - Street 1:610 FRENCH RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1014
Practice Address - Country:US
Practice Address - Phone:315-225-3534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192498-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty