Provider Demographics
NPI:1679836381
Name:JEFFERSON CARDIOVASCULAR AND THORACIC SERVICES
Entity Type:Organization
Organization Name:JEFFERSON CARDIOVASCULAR AND THORACIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:ECKENFELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-933-1107
Mailing Address - Street 1:1390 US HIGHWAY 61
Mailing Address - Street 2:SUITE 3301
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4137
Mailing Address - Country:US
Mailing Address - Phone:636-931-6302
Mailing Address - Fax:636-933-5055
Practice Address - Street 1:1390 US HIGHWAY 61
Practice Address - Street 2:SUITE 3301
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4137
Practice Address - Country:US
Practice Address - Phone:636-931-6302
Practice Address - Fax:636-933-5055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty