Provider Demographics
NPI:1710092440
Name:ADVANCED CARDIOVASCULAR AND THORACIC SURGICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:ADVANCED CARDIOVASCULAR AND THORACIC SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-634-9900
Mailing Address - Street 1:PO BOX 5668
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-8548
Mailing Address - Country:US
Mailing Address - Phone:530-634-9900
Mailing Address - Fax:530-634-9910
Practice Address - Street 1:414 G ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5663
Practice Address - Country:US
Practice Address - Phone:530-634-9900
Practice Address - Fax:530-634-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87647208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH30243Medicare UPIN