Provider Demographics
NPI:1417157223
Name:CARDIOVASCULAR AND THORACIC SURGICAL SPECIALISTS LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR AND THORACIC SURGICAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:SENDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-641-6150
Mailing Address - Street 1:P O BOX 8660
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-8660
Mailing Address - Country:US
Mailing Address - Phone:985-893-5639
Mailing Address - Fax:985-893-5641
Practice Address - Street 1:71380 HIGHWAY 21
Practice Address - Street 2:SUITE 104
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7245
Practice Address - Country:US
Practice Address - Phone:985-893-5639
Practice Address - Fax:985-893-5641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD13230R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1446505Medicaid
MS09015757Medicaid
LA1446505Medicaid