Provider Demographics
NPI:1689610032
Name:CARDIAC, VASCULAR & THORACIC SURGERY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CARDIAC, VASCULAR & THORACIC SURGERY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHA
Authorized Official - Phone:703-280-1473
Mailing Address - Street 1:2921 TELESTAR CT
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1205
Mailing Address - Country:US
Mailing Address - Phone:703-280-5858
Mailing Address - Fax:703-280-2654
Practice Address - Street 1:2921 TELESTAR CT
Practice Address - Street 2:SUITE 140
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1205
Practice Address - Country:US
Practice Address - Phone:703-280-5858
Practice Address - Fax:703-280-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty