Provider Demographics
NPI:1518211440
Name:CAPITAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:CAPITAL HEALTHCARE LLC
Other - Org Name:CAPITAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:USAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-212-0777
Mailing Address - Street 1:2700 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4547
Mailing Address - Country:US
Mailing Address - Phone:248-212-0777
Mailing Address - Fax:248-575-4144
Practice Address - Street 1:2700 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4547
Practice Address - Country:US
Practice Address - Phone:248-212-0777
Practice Address - Fax:248-575-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102325207T00000X, 208VP0000X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4958Medicaid
MI282287Medicaid
SC9089Medicare UPIN
SCGP4958Medicaid