Provider Demographics
NPI:1194718312
Name:CAPE COD ASC LLC
Entity type:Organization
Organization Name:CAPE COD ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-833-6050
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:280 HERITAGE PARK
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-0820
Mailing Address - Country:US
Mailing Address - Phone:508-833-6050
Mailing Address - Fax:508-833-6029
Practice Address - Street 1:280 HERITAGE PARK
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563
Practice Address - Country:US
Practice Address - Phone:508-833-6050
Practice Address - Fax:508-833-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
5453231OtherCCN
6800018OtherUNITED HEALTHCARE
505370OtherCIGNA
MAM77019OtherBCBS
1999325OtherFIRST HEALTH
MA806016OtherTUFTS
2160646OtherAETNA
903441OtherHARVARD PILGRIM
5453231OtherCCN