Provider Demographics
NPI:1447202726
Name:CARDIOVASCULAR & CHEST SURGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:CARDIOVASCULAR & CHEST SURGICAL ASSOCIATES, PA
Other - Org Name:CARDIOTHORACIC & VASCULAR ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HESGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-345-6545
Mailing Address - Street 1:333 N. 1ST ST.
Mailing Address - Street 2:#280
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-345-6545
Mailing Address - Fax:208-345-1213
Practice Address - Street 1:333 N. 1ST ST.
Practice Address - Street 2:#280
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-345-6545
Practice Address - Fax:208-345-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID89508OtherBLUE CROSS
ID000010026913OtherBLUE SHIELD
OR049841Medicaid
IDCO3057OtherRRMC
OR049841Medicaid