Provider Demographics
NPI:1740468396
Name:CARDIAC & VASCULAR SURGERY SPECIALIST, PA
Entity type:Organization
Organization Name:CARDIAC & VASCULAR SURGERY SPECIALIST, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:E
Authorized Official - Last Name:CROUSHORE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-6777
Mailing Address - Street 1:1121 NW 64TH TERR.
Mailing Address - Street 2:STE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-331-6777
Mailing Address - Fax:352-331-8899
Practice Address - Street 1:1121 NW 64TH TERR.
Practice Address - Street 2:STE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-331-6777
Practice Address - Fax:352-331-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2852Medicare PIN