Provider Demographics
NPI:1134675317
Name:CAPERNAUM MEDICAL CENTER
Entity Type:Organization
Organization Name:CAPERNAUM MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:VERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-361-9408
Mailing Address - Street 1:PO BOX 95448
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-5448
Mailing Address - Country:US
Mailing Address - Phone:212-361-9408
Mailing Address - Fax:
Practice Address - Street 1:5129 S LAKELAND DR
Practice Address - Street 2:UNIT 1 AND 2
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2598
Practice Address - Country:US
Practice Address - Phone:212-361-9408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Multi-Specialty