Provider Demographics
NPI:1932783149
Name:CARDIAC AND THORACIC SURGERY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CARDIAC AND THORACIC SURGERY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILIIAM
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPA
Authorized Official - Phone:225-963-0567
Mailing Address - Street 1:2223 QUAIL RUN STE E
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9063
Mailing Address - Country:US
Mailing Address - Phone:225-877-2872
Mailing Address - Fax:
Practice Address - Street 1:2223 QUAIL RUN STE E
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9063
Practice Address - Country:US
Practice Address - Phone:225-877-2872
Practice Address - Fax:225-659-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty