Provider Demographics
NPI:1629176664
Name:CAPE NEUROLOGICAL SURGEONS, P. C.
Entity Type:Organization
Organization Name:CAPE NEUROLOGICAL SURGEONS, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-334-9933
Mailing Address - Street 1:304 S MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4920
Mailing Address - Country:US
Mailing Address - Phone:573-334-9933
Mailing Address - Fax:573-334-9958
Practice Address - Street 1:304 S MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4920
Practice Address - Country:US
Practice Address - Phone:573-334-9933
Practice Address - Fax:573-334-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD109222174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203306907Medicaid
MO201119203Medicaid
MO208021915Medicaid
MO1225820001Medicare NSC
MOF24381Medicare UPIN
MO943923312Medicare ID - Type Unspecified
MO001013312Medicare ID - Type Unspecified
MO208021915Medicaid
MOI33481Medicare UPIN