Provider Demographics
NPI:1578742722
Name:THORACIC AND CARDIOVASCULAR ASSOCIATES
Entity Type:Organization
Organization Name:THORACIC AND CARDIOVASCULAR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELAIINE
Authorized Official - Last Name:MITCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-762-0366
Mailing Address - Street 1:75 ARCH ST
Mailing Address - Street 2:SUITE 412
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:SUITE 412
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-762-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0957782Medicaid
OHA75738Medicare UPIN
OH0957782Medicaid