Provider Demographics
NPI:1508913948
Name:SOUTHWESTERN CARDIOVASCULAR SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHWESTERN CARDIOVASCULAR SURGICAL ASSOCIATES
Other - Org Name:LUBBOCK HEART SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-792-8185
Mailing Address - Street 1:4408 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4732
Mailing Address - Country:US
Mailing Address - Phone:806-792-8185
Mailing Address - Fax:806-792-9180
Practice Address - Street 1:4408 6TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4732
Practice Address - Country:US
Practice Address - Phone:806-792-8185
Practice Address - Fax:806-792-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-10-10
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
TX094904202Medicaid
00FM38OtherBLUE CROSS BLUE SHIELD
TX094904202Medicaid