Provider Demographics
NPI:1073872289
Name:CAPE VISTA ENTERPRISES INC
Entity Type:Organization
Organization Name:CAPE VISTA ENTERPRISES INC
Other - Org Name:VISTAMED CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ADEBISI
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:813-454-7775
Mailing Address - Street 1:2734 WINDGUARD CIR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7362
Mailing Address - Country:US
Mailing Address - Phone:813-991-4333
Mailing Address - Fax:813-440-2744
Practice Address - Street 1:2734 WINDGUARD CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7362
Practice Address - Country:US
Practice Address - Phone:813-991-4333
Practice Address - Fax:813-440-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9357261QH0100X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service