Provider Demographics
NPI:1932160330
Name:CARDIOTHORACIC SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:CARDIOTHORACIC SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DILIBERTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:727-398-9600
Mailing Address - Street 1:8588 STARKEY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-2831
Mailing Address - Country:US
Mailing Address - Phone:727-398-9600
Mailing Address - Fax:727-394-8814
Practice Address - Street 1:8588 STARKEY RD
Practice Address - Street 2:SUITE E
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-2831
Practice Address - Country:US
Practice Address - Phone:727-398-9600
Practice Address - Fax:727-394-8814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208G00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263067200Medicaid
FLME064174OtherSTATE MEDICAL LICENSE
FL263067200Medicaid
FL23283ZMedicare ID - Type Unspecified