Provider Demographics
NPI:1912009820
Name:CARDIOPULMONARY SURGICAL ASSOCIATES, PLC
Entity Type:Organization
Organization Name:CARDIOPULMONARY SURGICAL ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:DREICER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-835-2250
Mailing Address - Street 1:PO BOX 7327
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7327
Mailing Address - Country:US
Mailing Address - Phone:480-835-2250
Mailing Address - Fax:480-835-2324
Practice Address - Street 1:655 S DOBSON RD
Practice Address - Street 2:#A-108
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5667
Practice Address - Country:US
Practice Address - Phone:480-835-2250
Practice Address - Fax:480-835-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-05-27
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
AZ77970Medicare ID - Type UnspecifiedGROUP NUMBER