Provider Demographics
NPI:1437263472
Name:CARDIO-THORACIC SURGERY PA A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CARDIO-THORACIC SURGERY PA A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MT BB
Authorized Official - Phone:985-882-6221
Mailing Address - Street 1:64040 HWY 434
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445
Mailing Address - Country:US
Mailing Address - Phone:985-882-6221
Mailing Address - Fax:985-882-7935
Practice Address - Street 1:64040 HWY 434
Practice Address - Street 2:SUITE 100
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445
Practice Address - Country:US
Practice Address - Phone:985-882-6221
Practice Address - Fax:985-882-7935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2013-09-04
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
LA1440221Medicaid
MS09015239Medicaid
5C686Medicare ID - Type Unspecified