Provider Demographics
NPI:1821093220
Name:CARDIAC SURGICAL ASSOCIATES LLP
Entity Type:Organization
Organization Name:CARDIAC SURGICAL ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-527-9779
Mailing Address - Street 1:6006 49TH ST N
Mailing Address - Street 2:STE 310
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2149
Mailing Address - Country:US
Mailing Address - Phone:727-527-9779
Mailing Address - Fax:727-522-0415
Practice Address - Street 1:6006 49TH ST N
Practice Address - Street 2:STE 310
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2149
Practice Address - Country:US
Practice Address - Phone:727-527-9779
Practice Address - Fax:727-522-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2014-05-09
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
FL133851OtherWELLCARE
FL1040683001OtherCIGNA
FL3303663OtherAETNA
FL213046OtherAMERIGROUP
FL239304OtherAVMED
FL2122308OtherHUMANA
FL254837200Medicaid
18-00123OtherUNITED
FL239304OtherAVMED
18-00123OtherUNITED