Provider Demographics
NPI:1043431760
Name:ASSOCIATED THORACIC & CARDIOVASCULAR SURGEONS, LTD
Entity Type:Organization
Organization Name:ASSOCIATED THORACIC & CARDIOVASCULAR SURGEONS, LTD
Other - Org Name:CARDIOTHORACIC & VASCULAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:480-661-4761
Mailing Address - Street 1:PO BOX 14390
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-4390
Mailing Address - Country:US
Mailing Address - Phone:480-661-4761
Mailing Address - Fax:480-661-3990
Practice Address - Street 1:26224 N TATUM BLVD STE 11
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-7500
Practice Address - Country:US
Practice Address - Phone:480-661-4761
Practice Address - Fax:480-661-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1780688135OtherNPPES
AZZWDBCJMedicare PIN