Provider Demographics
NPI:1639328131
Name:CARDIOVASCULAR AND THORACIC SPECIALISTS, LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR AND THORACIC SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:V. ANTOINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-752-0915
Mailing Address - Street 1:PO BOX 84859
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-4859
Mailing Address - Country:US
Mailing Address - Phone:225-752-0915
Mailing Address - Fax:225-752-5884
Practice Address - Street 1:413 HIGHLAND CROSSING ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-5816
Practice Address - Country:US
Practice Address - Phone:225-752-0915
Practice Address - Fax:225-752-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021788208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty