Provider Demographics
NPI:1396856431
Name:CARDIAC SURGERY ASSOCIATES OF TAMPA
Entity Type:Organization
Organization Name:CARDIAC SURGERY ASSOCIATES OF TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-910-0027
Mailing Address - Street 1:3000 E FLETCHER AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4656
Mailing Address - Country:US
Mailing Address - Phone:813-910-0027
Mailing Address - Fax:813-971-1286
Practice Address - Street 1:3000 E FLETCHER AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4656
Practice Address - Country:US
Practice Address - Phone:813-910-0027
Practice Address - Fax:813-971-1286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-10-26
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
FL256523400Medicaid
FL21933Medicare ID - Type Unspecified