Provider Demographics
NPI:1134122047
Name:CAPE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:CAPE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSALESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-246-9499
Mailing Address - Street 1:555 E NORTH LN STE 5075
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2490
Mailing Address - Country:US
Mailing Address - Phone:610-424-4515
Mailing Address - Fax:
Practice Address - Street 1:28 JAN SEBASTIAN DR
Practice Address - Street 2:UNIT 2
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2361
Practice Address - Country:US
Practice Address - Phone:508-283-3767
Practice Address - Fax:508-888-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1519344Medicaid
MA238754OtherBLUE CROSS BLUE SHIELD
MA801682OtherTUFTS HEALTHCARE
MA238754OtherBLUE CROSS BLUE SHIELD