Provider Demographics
NPI: | 1922508514 |
---|---|
Name: | NORTHSTARR CARDIOTHORACIC SURGERY, LLC |
Entity Type: | Organization |
Organization Name: | NORTHSTARR CARDIOTHORACIC SURGERY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LISA |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | ANDERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 503-297-1419 |
Mailing Address - Street 1: | PO BOX 35145 |
Mailing Address - Street 2: | #196240 |
Mailing Address - City: | SEATTLE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98124-5145 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-297-1419 |
Mailing Address - Fax: | 503-512-7916 |
Practice Address - Street 1: | 3841 PIPER ST # T382 |
Practice Address - Street 2: | |
Practice Address - City: | ANCHORAGE |
Practice Address - State: | AK |
Practice Address - Zip Code: | 99508-4624 |
Practice Address - Country: | US |
Practice Address - Phone: | 907-917-2200 |
Practice Address - Fax: | 907-865-7944 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-02-20 |
Last Update Date: | 2023-10-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Single Specialty |