Provider Demographics
NPI:1356453773
Name:THORACIC AND CARDIOVASCULAR SURGERY ASSOCIATION
Entity Type:Organization
Organization Name:THORACIC AND CARDIOVASCULAR SURGERY ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:SCHOETTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-725-9450
Mailing Address - Street 1:1325 EASTMORELAND AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3519
Mailing Address - Country:US
Mailing Address - Phone:901-725-9450
Mailing Address - Fax:901-462-0675
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-725-9450
Practice Address - Fax:901-462-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3372262Medicare ID - Type UnspecifiedPTAN
TN3372261Medicare ID - Type UnspecifiedPTAN