Provider Demographics
NPI:1326061714
Name:CARDIOTHORACIC AND VASCULAR SURGEONS,PA
Entity Type:Organization
Organization Name:CARDIOTHORACIC AND VASCULAR SURGEONS,PA
Other - Org Name:VEINSOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-459-8753
Mailing Address - Street 1:1010 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4010
Mailing Address - Country:US
Mailing Address - Phone:512-459-8753
Mailing Address - Fax:512-651-8441
Practice Address - Street 1:1010 W 40TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4010
Practice Address - Country:US
Practice Address - Phone:512-459-8753
Practice Address - Fax:512-651-8441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIOTHORACIC AND VASCULAR SURGEONS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1326061714OtherNPI
TX0025DMOtherSAN ANGELO BCBS GROUP NO
TX00R517OtherBCBS AUSTIN GROUP NO
TX121680602Medicaid
TX=========OtherTAX ID NO
TX00R517OtherBCBS AUSTIN GROUP NO
TX121680602Medicaid