Provider Demographics
NPI:1891776811
Name:NORTH CENTRAL CARDIOVASCULAR AND THORACIC SURGEON PC
Entity Type:Organization
Organization Name:NORTH CENTRAL CARDIOVASCULAR AND THORACIC SURGEON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-567-1041
Mailing Address - Street 1:777 RURAL AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3109
Mailing Address - Country:US
Mailing Address - Phone:570-567-1041
Mailing Address - Fax:570-567-1044
Practice Address - Street 1:777 RURAL AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3109
Practice Address - Country:US
Practice Address - Phone:570-567-1041
Practice Address - Fax:570-567-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-08-22
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
PA0018681950001Medicaid
PA1322883OtherBLUE SHIELD
PA051464Medicare ID - Type Unspecified