Provider Demographics
NPI:1659438869
Name:THORACIC & CARDIOVASCULAR SURGERY INC PS
Entity Type:Organization
Organization Name:THORACIC & CARDIOVASCULAR SURGERY INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-452-0279
Mailing Address - Street 1:602 N 39TH AVE
Mailing Address - Street 2:200
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902
Mailing Address - Country:US
Mailing Address - Phone:509-452-0279
Mailing Address - Fax:509-457-6306
Practice Address - Street 1:602 N 39TH AVE
Practice Address - Street 2:200
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-452-0279
Practice Address - Fax:509-457-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0048700OtherLABOR & INDUSTRIES
WA7059694Medicaid
WA8902478OtherCRIME VICTIMS