Provider Demographics
NPI:1063673184
Name:CARDIAC SURGERY ASSOCIATES, PC
Entity Type:Organization
Organization Name:CARDIAC SURGERY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-747-0017
Mailing Address - Street 1:6029 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2112
Mailing Address - Country:US
Mailing Address - Phone:901-747-0017
Mailing Address - Fax:901-747-0016
Practice Address - Street 1:6029 WALNUT GROVE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-747-0017
Practice Address - Fax:901-747-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty