Basic Information
| Provider Information | |||||||||
| NPI: | 1144743410 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY HEALTH CENTER OF CAPE COD, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 COMMERCIAL ST | ||||||||
| Address2: | |||||||||
| City: | MASHPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026496507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084777090 | ||||||||
| FaxNumber: | 5084777028 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 WATERHOUSE RD | ||||||||
| Address2: | |||||||||
| City: | BOURNE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025323890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085396000 | ||||||||
| FaxNumber: | 5084777028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2017 | ||||||||
| LastUpdateDate: | 07/19/2017 | ||||||||
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| AuthorizedOfficialLastName: | GARDNER | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5084777090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | MA | Y | Suppliers | Pharmacy | Clinic Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 110027778F | 05 | MA | MEDICAID |