Provider Demographics
NPI:1255464301
Name:CARDIOTHORACIC SURGERY GROUP, LLC
Entity Type:Organization
Organization Name:CARDIOTHORACIC SURGERY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRIBE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESPINAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC, FACS
Authorized Official - Phone:330-384-9001
Mailing Address - Street 1:75 ARCH ST STE 407
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1433
Mailing Address - Country:US
Mailing Address - Phone:330-384-9001
Mailing Address - Fax:330-384-9002
Practice Address - Street 1:75 ARCH ST STE 407
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1433
Practice Address - Country:US
Practice Address - Phone:330-384-9001
Practice Address - Fax:330-384-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2459147Medicaid
OHCA9339161Medicare ID - Type Unspecified