=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831194026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARASOTA CARDIOVASCULAR & THORACIC SURGICAL ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2005
-----------------------------------------------------
Last Update Date | 01/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1540 S TAMIAMI TRL STE 301
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-2921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-952-1913
-----------------------------------------------------
Fax | 941-952-1969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1540 S TAMIAMI TRL STE 301
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-2921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-952-1913
-----------------------------------------------------
Fax | 941-952-1969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. RITA HORN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-952-1947
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | 586400296
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------