Provider Demographics
NPI:1407149362
Name:CAPITAL HEALTH PLAN INC
Entity Type:Organization
Organization Name:CAPITAL HEALTH PLAN INC
Other - Org Name:CHP URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAWEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-383-3427
Mailing Address - Street 1:2140 CENTERVILLE PLACE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4314
Mailing Address - Country:US
Mailing Address - Phone:850-383-3382
Mailing Address - Fax:
Practice Address - Street 1:1264 METROPOLITAN BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-2536
Practice Address - Country:US
Practice Address - Phone:850-383-3382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL HEALTH PLAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-25
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization