Provider Demographics
NPI:1114983673
Name:CARDIOVASCULAR & THORACIC SURGERY OF ALTOONA, INC.
Entity Type:Organization
Organization Name:CARDIOVASCULAR & THORACIC SURGERY OF ALTOONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-889-7707
Mailing Address - Street 1:620 HOWARD AVE
Mailing Address - Street 2:BLDG 7-F
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4804
Mailing Address - Country:US
Mailing Address - Phone:814-946-2328
Mailing Address - Fax:814-946-7724
Practice Address - Street 1:620 HOWARD AVE
Practice Address - Street 2:BLDG 7-F
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4804
Practice Address - Country:US
Practice Address - Phone:814-946-2328
Practice Address - Fax:814-946-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012720790001Medicaid
PA0012720790001Medicaid