Provider Demographics
NPI:1932581337
Name:CAPE COD ORTHOPEDICS AND SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:CAPE COD ORTHOPEDICS AND SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-775-8282
Mailing Address - Street 1:PO BOX 2019
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2019
Mailing Address - Country:US
Mailing Address - Phone:508-775-8282
Mailing Address - Fax:508-775-1414
Practice Address - Street 1:18 ROUTE 6A
Practice Address - Street 2:BLDG 2
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-5309
Practice Address - Country:US
Practice Address - Phone:508-775-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty