Provider Demographics
NPI:1407046642
Name:CAPITAL HOSPICE
Entity type:Organization
Organization Name:CAPITAL HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, LEGAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-871-8075
Mailing Address - Street 1:12470 TELECOM DR, STE 301
Mailing Address - Street 2:ATTN: LEGAL SVS
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0904
Mailing Address - Country:US
Mailing Address - Phone:813-871-8111
Mailing Address - Fax:
Practice Address - Street 1:1801 MCCORMICK DR STE 180
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5345
Practice Address - Country:US
Practice Address - Phone:703-538-2066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400403500Medicaid