Provider Demographics
NPI:1831529866
Name:SOUTHERN CARDIAC AND VASCULAR ASSOCIATES, LLC
Entity type:Organization
Organization Name:SOUTHERN CARDIAC AND VASCULAR ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS/PT ACCOUNTS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-878-6164
Mailing Address - Street 1:1405 CENTERVILLE RD STE 5000
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4663
Mailing Address - Country:US
Mailing Address - Phone:850-878-6164
Mailing Address - Fax:850-656-5575
Practice Address - Street 1:1405 CENTERVILLE RD STE 5000
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4663
Practice Address - Country:US
Practice Address - Phone:850-878-6164
Practice Address - Fax:850-656-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty