MEDICARE: CARDIOVASCULAR AND THORACIC SURGICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1053464669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR AND THORACIC SURGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1600 N GRAND AVE STE 500
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2757
Country	:	US
Telephone Number	:	719-545-0663
Fax Number	:	719-545-6994

Provider Business Practice Location Address
First Line	:	1600 N GRAND AVE STE 500
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2757
Country	:	US
Telephone Number	:	719-545-0663
Fax Number	:	719-545-6994

Authorized Official
Title or Position	:	OWNER
Name	:	GREG A. BOWMAN
Credential	:	M.D.
Telephone Number	:	719-545-0663

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	08/22/2020

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