Provider Demographics
NPI:1073548608
Name:CARDIOTHORACIC SURGERY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CARDIOTHORACIC SURGERY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:BATES
Authorized Official - Last Name:DAILY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:618-233-5722
Mailing Address - Street 1:9 PARK PL STE B
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2967
Mailing Address - Country:US
Mailing Address - Phone:618-233-5722
Mailing Address - Fax:618-233-7069
Practice Address - Street 1:9 PARK PL STE B
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2967
Practice Address - Country:US
Practice Address - Phone:618-233-5722
Practice Address - Fax:618-233-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSSN#
MO102265OtherMISSOURI LICENSE
MO118539OtherMISSOURI LICENSE
MO2003008000OtherMISSOURI LICENSE
G07405Medicare UPIN
I27370Medicare UPIN
F05855Medicare UPIN
MO102265OtherMISSOURI LICENSE
MO2003008000OtherMISSOURI LICENSE
I49218Medicare UPIN
H29391Medicare UPIN
H46484Medicare UPIN
P96459Medicare UPIN
Q05724Medicare UPIN
R78380Medicare UPIN
S49899Medicare UPIN
F84702Medicare UPIN
MO118539OtherMISSOURI LICENSE