Provider Demographics
NPI:1649212416
Name:THORACIC & CARDIOVASCULAR SURGEONS LLC
Entity Type:Organization
Organization Name:THORACIC & CARDIOVASCULAR SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-548-4900
Mailing Address - Street 1:5301 S CONGRESS AVE
Mailing Address - Street 2:BLDG. #300
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1149
Mailing Address - Country:US
Mailing Address - Phone:561-548-4900
Mailing Address - Fax:561-548-4902
Practice Address - Street 1:5301 S CONGRESS AVE
Practice Address - Street 2:BLDG. #300
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1149
Practice Address - Country:US
Practice Address - Phone:561-548-4900
Practice Address - Fax:561-548-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2007-08-29
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
FL74765OtherBCBS OF FL
FLK4403Medicare ID - Type UnspecifiedMEDICARE BCBS