Provider Demographics
NPI:1770688566
Name:CAPITAL HEALTH PLAN, INC,
Entity Type:Organization
Organization Name:CAPITAL HEALTH PLAN, INC,
Other - Org Name:CAPITAL GROUP HEALTH SERVICES OF FLORIDA, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
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:PO BOX 15349
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-5349
Mailing Address - Country:US
Mailing Address - Phone:850-383-3333
Mailing Address - Fax:850-383-3441
Practice Address - Street 1:2140 CENTERVILLE PL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-383-3333
Practice Address - Fax:850-383-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL03-302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98009Medicare ID - Type Unspecified