Basic Information
| Provider Information | |||||||||
| NPI: | 1528245271 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | USCG CLINIC CAPE MAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MUNRO AVE | ||||||||
| Address2: | HEALTH SERVICES DIVISION | ||||||||
| City: | CAPE MAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082045000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098986900 | ||||||||
| FaxNumber: | 6098986962 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MUNRO AVE | ||||||||
| Address2: | HEALTH SERVICES DIVISION | ||||||||
| City: | CAPE MAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082045000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098986900 | ||||||||
| FaxNumber: | 6098986962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2008 | ||||||||
| LastUpdateDate: | 01/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | COFIELD | ||||||||
| AuthorizedOfficialFirstName: | BERNARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6098986860 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | U. S. COAST GUARD | ||||||||
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| AuthorizedOfficialCredential: | LT, USCG | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1100X | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Military/U.S. Coast Guard Outpatient |
No ID Information.