Provider Demographics
NPI:1669945887
Name:MEEA-CAPE COD PHO LLC
Entity type:Organization
Organization Name:MEEA-CAPE COD PHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-573-6950
Mailing Address - Street 1:300 CROWN COLONY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0904
Mailing Address - Country:US
Mailing Address - Phone:617-804-4789
Mailing Address - Fax:
Practice Address - Street 1:5 INDUSTRIAL DR STE 201
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3465
Practice Address - Country:US
Practice Address - Phone:508-539-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty