Provider Demographics
NPI:1144419268
Name:CARDIAC SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CARDIAC SURGICAL ASSOCIATES, PLLC
Other - Org Name:CARDIAC SURGICAL ASSOCIATES,PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:SALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-977-0898
Mailing Address - Street 1:1451 HARRODSBURG RD STE D302
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3772
Mailing Address - Country:US
Mailing Address - Phone:859-977-0898
Mailing Address - Fax:859-260-7719
Practice Address - Street 1:1451 HARRODSBURG RD STE D302
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3772
Practice Address - Country:US
Practice Address - Phone:859-977-0898
Practice Address - Fax:859-260-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26256208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9132Medicare PIN