Basic Information
| Provider Information | |||||||||
| NPI: | 1689848244 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CAPE AND ISLANDS OCCUPATIONAL MEDICINE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 ATTUCKS LN | ||||||||
| Address2: | SUITE | ||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026011809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087715770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 ATTUCKS LN | ||||||||
| Address2: | SUITE 1-E | ||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026011809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087715770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 04/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | WINKEL | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5087715770 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | 210013 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8045125 | 01 | MA | CIGNA | OTHER | J25090 | 01 | MA | BLUE SHIELD | OTHER | 0195979 | 05 | MA | MEDICAID | 2202208 | 01 | MA | UNITED | OTHER | AA10815 | 01 | MA | HARVARD PILGRIM HEALTH CA | OTHER | 210013 | 01 | MA | TUFTS | OTHER |