1821093220 NPI number — CARDIAC SURGICAL ASSOCIATES LLP

Table of content: (NPI 1821093220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821093220 NPI number — CARDIAC SURGICAL ASSOCIATES LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIAC SURGICAL ASSOCIATES LLP
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:
1821093220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6006 49TH ST N
Provider Second Line Business Mailing Address:
STE 310
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33709-2149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-527-9779
Provider Business Mailing Address Fax Number:
727-522-0415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6006 49TH ST N
Provider Second Line Business Practice Location Address:
STE 310
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33709-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-527-9779
Provider Business Practice Location Address Fax Number:
727-522-0415
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PATRICK
Authorized Official First Name:
MONIQUE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
727-527-9779

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 133851 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1040683001 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3303663 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 213046 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 239304 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2122308 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 254837200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18-00123 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".




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