Provider Demographics
NPI:1013367440
Name:CAPERTON FERTILITY INSTITUTE, LLC
Entity Type:Organization
Organization Name:CAPERTON FERTILITY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPERTON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:505-553-3535
Mailing Address - Street 1:6500 JEFFERSON ST NE STE 250
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3490
Mailing Address - Country:US
Mailing Address - Phone:505-702-8020
Mailing Address - Fax:505-796-8022
Practice Address - Street 1:6500 JEFFERSON ST NE STE 250
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3490
Practice Address - Country:US
Practice Address - Phone:505-702-8020
Practice Address - Fax:505-796-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0092174400000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1609984905OtherNPI
NM1730253477OtherNPI