Provider Demographics
NPI:1093945156
Name:BASIN CARDIOTHORACIC & VASCULAR SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:BASIN CARDIOTHORACIC & VASCULAR SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-686-6600
Mailing Address - Street 1:PO BOX 5293
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5293
Mailing Address - Country:US
Mailing Address - Phone:432-686-6600
Mailing Address - Fax:432-682-2284
Practice Address - Street 1:3001 W ILLINOIS AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3180
Practice Address - Country:US
Practice Address - Phone:432-682-2191
Practice Address - Fax:432-682-1707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER FAMILY CARE I, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty