1417157223 NPI number — CARDIOVASCULAR AND THORACIC SURGICAL SPECIALISTS LLC

Table of content: (NPI 1417157223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417157223 NPI number — CARDIOVASCULAR AND THORACIC SURGICAL SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR AND THORACIC SURGICAL SPECIALISTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417157223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 8660
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70470-8660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-893-5639
Provider Business Mailing Address Fax Number:
985-893-5641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71380 HIGHWAY 21
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-7245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-893-5639
Provider Business Practice Location Address Fax Number:
985-893-5641
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SENDRA
Authorized Official First Name:
FIDEL
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
985-641-6150

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD13230R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1446505 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09015757 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com