Provider Demographics
NPI:1205033701
Name:CENTRAL FLORIDA CARDIOTHORACIC SURGERY PA
Entity Type:Organization
Organization Name:CENTRAL FLORIDA CARDIOTHORACIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-645-4017
Mailing Address - Street 1:1355 ORANGE AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4933
Mailing Address - Country:US
Mailing Address - Phone:407-645-4017
Mailing Address - Fax:407-645-4018
Practice Address - Street 1:1355 ORANGE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4933
Practice Address - Country:US
Practice Address - Phone:407-645-4017
Practice Address - Fax:407-645-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
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
FLK0257Medicare ID - Type UnspecifiedMEDICARE