Basic Information
| Provider Information | |||||||||
| NPI: | 1821093220 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIAC SURGICAL ASSOCIATES LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6006 49TH ST N | ||||||||
| Address2: | STE 310 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275279779 | ||||||||
| FaxNumber: | 7275220415 | ||||||||
| Practice Location | |||||||||
| Address1: | 6006 49TH ST N | ||||||||
| Address2: | STE 310 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275279779 | ||||||||
| FaxNumber: | 7275220415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 05/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | PATRICK | ||||||||
| AuthorizedOfficialFirstName: | MONIQUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7275279779 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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) |
ID Information
| ID | Type | State | Issuer | Description | 133851 | 01 | FL | WELLCARE | OTHER | 1040683001 | 01 | FL | CIGNA | OTHER | 3303663 | 01 | FL | AETNA | OTHER | 213046 | 01 | FL | AMERIGROUP | OTHER | 239304 | 01 | FL | AVMED | OTHER | 2122308 | 01 | FL | HUMANA | OTHER | 254837200 | 05 | FL | MEDICAID | 18-00123 | 01 | UNITED | OTHER |