Provider Demographics
NPI:1457536336
Name:CARDIOTHORACIC SURGERY, P.C.
Entity Type:Organization
Organization Name:CARDIOTHORACIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-237-0644
Mailing Address - Street 1:707 N MICHIGAN ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1067
Mailing Address - Country:US
Mailing Address - Phone:574-237-0644
Mailing Address - Fax:574-234-6986
Practice Address - Street 1:707 N MICHIGAN ST
Practice Address - Street 2:SUITE 501
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1067
Practice Address - Country:US
Practice Address - Phone:574-237-0644
Practice Address - Fax:574-234-6986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037310208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE86546Medicare UPIN
INA16598Medicare UPIN
INB89029Medicare UPIN
IN208G00000XMedicare PIN
INP96574Medicare UPIN
INR97494Medicare UPIN
INH87612Medicare UPIN
INQ42083Medicare UPIN
INE02136Medicare UPIN