MEDICARE: CARDIOTHORACIC SURGERY, LLC

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DD6946	OTHER	MO	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104895812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOTHORACIC SURGERY, LLC

Provider Business Mailing Address
First Line	:	232 S WOODS MILL RD
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3406
Country	:	US
Telephone Number	:	314-576-2490
Fax Number	:	314-576-2473

Provider Business Practice Location Address
First Line	:	222 S WOODS MILL RD
Second Line	:	SUITE 550-N
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3625
Country	:	US
Telephone Number	:	314-434-3049
Fax Number	:	314-205-6916

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DARREN R. HASKELL
Credential	:	MD.
Telephone Number	:	314-205-6444

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	03/05/2026

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Directions to “CARDIOTHORACIC SURGERY, LLC ” Practice Location

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