Provider Demographics
NPI:1568521003
Name:CARDIOTHORACIC SURGEONS INC
Entity Type:Organization
Organization Name:CARDIOTHORACIC SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:FANNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-856-9100
Mailing Address - Street 1:85 MCNAUGHTEN ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-5111
Mailing Address - Country:US
Mailing Address - Phone:614-856-9100
Mailing Address - Fax:614-856-9191
Practice Address - Street 1:85 MCNAUGHTEN ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-5111
Practice Address - Country:US
Practice Address - Phone:614-856-9100
Practice Address - Fax:614-856-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2007-10-11
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
OH0741648Medicaid
OH0741648Medicaid