Provider Demographics
NPI:1457399859
Name:CARDIOVASCULAR SURGICAL SPECIALISTS CORP
Entity Type:Organization
Organization Name:CARDIOVASCULAR SURGICAL SPECIALISTS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT OF COMPANY
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SHAKER
Authorized Official - Last Name:COHLMIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:918-584-2500
Mailing Address - Street 1:2448 E 81ST ST
Mailing Address - Street 2:SUITE 5100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4250
Mailing Address - Country:US
Mailing Address - Phone:918-584-2500
Mailing Address - Fax:918-584-4634
Practice Address - Street 1:1373 E BOONE ST
Practice Address - Street 2:SUITE 3400
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3364
Practice Address - Country:US
Practice Address - Phone:918-456-9500
Practice Address - Fax:918-456-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKJ=========6Medicaid
OK513547119PMedicare ID - Type UnspecifiedDR. COHLMIA'S MEDICARE
OKJ=========6Medicaid