MEDICARE: GULF COAST CARDIOTHORACIC SURGERY INSTITUTE, INC

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

General Provider Information

NPI Number	:	1578933115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST CARDIOTHORACIC SURGERY INSTITUTE, INC

Provider Business Mailing Address
First Line	:	17 DAVIS BLVD
Second Line	:	313
City	:	TAMPA
State	:	FL
Zip	:	33606-3475
Country	:	US
Telephone Number	:	813-906-1400
Fax Number	:	813-354-2321

Provider Business Practice Location Address
First Line	:	101 W BEACH PL
Second Line	:	1800
City	:	TAMPA
State	:	FL
Zip	:	33606-2334
Country	:	US
Telephone Number	:	813-906-1400
Fax Number	:	813-354-2321

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MICHAEL E ERHARD
Credential	:	CMPE
Telephone Number	:	707-363-7627

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	03/02/2017

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