Provider Demographics
NPI:1619997533
Name:CARDIAC AND VASCULAR ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CARDIAC AND VASCULAR ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:A
Authorized Official - Last Name:STRATIENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-693-2400
Mailing Address - Street 1:1032 MCCALLIE AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2800
Mailing Address - Country:US
Mailing Address - Phone:423-693-2400
Mailing Address - Fax:423-693-2499
Practice Address - Street 1:1032 MCCALLIE AVE
Practice Address - Street 2:STE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2800
Practice Address - Country:US
Practice Address - Phone:423-693-2400
Practice Address - Fax:423-693-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24470207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG7405OtherRAILROAD MEDICARE
AL529907170Medicaid
TN3374434Medicare PIN