Basic Information
| Provider Information | |||||||||
| NPI: | 1043309628 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CVT SURGERY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6804 S CANTON AVE | ||||||||
| Address2: | 110 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187496400 | ||||||||
| FaxNumber: | 9183883999 | ||||||||
| Practice Location | |||||||||
| Address1: | 6804 S CANTON AVE | ||||||||
| Address2: | 110 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187496400 | ||||||||
| FaxNumber: | 9183883999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHITENECK | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/SURGEON | ||||||||
| AuthorizedOfficialTelephone: | 9187496400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.