Provider Demographics
NPI:1245331669
Name:CARDIOTHORACIC SURGERY, LLC
Entity type:Organization
Organization Name:CARDIOTHORACIC SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-963-1740
Mailing Address - Street 1:1360 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2803
Mailing Address - Country:US
Mailing Address - Phone:570-963-1740
Mailing Address - Fax:570-963-5780
Practice Address - Street 1:1800 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2369
Practice Address - Country:US
Practice Address - Phone:570-963-1740
Practice Address - Fax:570-963-5780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMCI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA073284Medicare PIN
PA047968Medicare PIN
PA402486Medicare PIN
PA094885Medicare PIN