Provider Demographics
NPI:1891754586
Name:THORACIC & CARDIOVASCULAR ASSOCIATES, PA
Entity Type:Organization
Organization Name:THORACIC & CARDIOVASCULAR ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-254-5140
Mailing Address - Street 1:2750 LAUREL ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2038
Mailing Address - Country:US
Mailing Address - Phone:803-254-5140
Mailing Address - Fax:803-779-1279
Practice Address - Street 1:2750 LAUREL ST
Practice Address - Street 2:SUITE 305
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2038
Practice Address - Country:US
Practice Address - Phone:803-254-5140
Practice Address - Fax:803-779-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB4461OtherRAILROAD MEDICARE
SCPA1293Medicaid
SC1794Medicare PIN