Provider Demographics
NPI:1407384795
Name:CAPE CORAL PRIMARY CARE LLC
Entity Type:Organization
Organization Name:CAPE CORAL PRIMARY CARE LLC
Other - Org Name:CAPE CORAL PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-360-2638
Mailing Address - Street 1:811 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2666
Mailing Address - Country:US
Mailing Address - Phone:239-360-2638
Mailing Address - Fax:239-360-2701
Practice Address - Street 1:811 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2666
Practice Address - Country:US
Practice Address - Phone:239-360-2634
Practice Address - Fax:239-360-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty