Provider Demographics
NPI:1093024333
Name:CARDIOTHORACIC SURGERY OF HYDE PARK INC
Entity Type:Organization
Organization Name:CARDIOTHORACIC SURGERY OF HYDE PARK INC
Other - Org Name:MILLENNIUM HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEKELL-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-498-8898
Mailing Address - Street 1:301 W PLATT ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2292
Mailing Address - Country:US
Mailing Address - Phone:727-498-8898
Mailing Address - Fax:727-800-6959
Practice Address - Street 1:8950 9TH ST N STE 102
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3001
Practice Address - Country:US
Practice Address - Phone:727-498-8898
Practice Address - Fax:727-800-6959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1790390011Medicaid
FL1912971292Medicaid
FL1982649935Medicaid
FL1609489541Medicaid