Provider Demographics
NPI:1225449374
Name:CAPITAL CITY MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:CAPITAL CITY MEDICAL GROUP, LLC
Other - Org Name:PRIMARY CARE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-681-8532
Mailing Address - Street 1:3838 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 2550
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-8194
Mailing Address - Country:US
Mailing Address - Phone:504-681-8259
Mailing Address - Fax:504-681-8260
Practice Address - Street 1:7049 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-926-7200
Practice Address - Fax:225-706-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty