Healthcare Provider Details

I. General information

NPI: 1326061714
Provider Name (Legal Business Name): CARDIOTHORACIC AND VASCULAR SURGEONS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W 40TH ST
AUSTIN TX
78756-4010
US

IV. Provider business mailing address

1010 W 40TH ST
AUSTIN TX
78756-4010
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-8753
  • Fax: 512-651-8441
Mailing address:
  • Phone: 512-459-8753
  • Fax: 512-651-8441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W JOHNSON
Title or Position: CFO
Credential:
Phone: 512-459-8753