Provider Demographics
NPI:1851759864
Name:CAPE SIERRA CLINIC LLC
Entity Type:Organization
Organization Name:CAPE SIERRA CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BANGURA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:615-396-8997
Mailing Address - Street 1:6688 NOLENSVILLE RD STE 108-41
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5630 NOLENSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6422
Practice Address - Country:US
Practice Address - Phone:615-396-8997
Practice Address - Fax:615-809-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care