Healthcare Provider Details

I. General information

NPI: 1275520348
Provider Name (Legal Business Name): TSA THORACIC SURGICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 MERCY DR NW SUITE 502
CANTON OH
44708-2626
US

IV. Provider business mailing address

PO BOX 76804
CLEVELAND OH
44101-6500
US

V. Phone/Fax

Practice location:
  • Phone: 330-489-1427
  • Fax:
Mailing address:
  • Phone: 330-489-1427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: VICKI P CHRYSSOS
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 330-489-1427