Provider Demographics
NPI:1023039195
Name:CAPE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CAPE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-285-1545
Mailing Address - Street 1:401 E TICKLE ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3163
Mailing Address - Country:US
Mailing Address - Phone:731-285-1545
Mailing Address - Fax:731-286-0433
Practice Address - Street 1:401 E TICKLE ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3163
Practice Address - Country:US
Practice Address - Phone:731-285-1545
Practice Address - Fax:731-286-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN184261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI09564Medicare UPIN
TNF20233Medicare UPIN