MEDICARE: CARDIAC SURGICAL ASSOCIATES LLP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	133851	OTHER	FL	WELLCARE
2	1040683001	OTHER	FL	CIGNA
3	3303663	OTHER	FL	AETNA
4	213046	OTHER	FL	AMERIGROUP
5	239304	OTHER	FL	AVMED
6	2122308	OTHER	FL	HUMANA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	18-00123	OTHER		UNITED

General Provider Information

NPI Number	:	1821093220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC SURGICAL ASSOCIATES LLP

Provider Business Mailing Address
First Line	:	6006 49TH ST N
Second Line	:	STE 310
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2149
Country	:	US
Telephone Number	:	727-527-9779
Fax Number	:	727-522-0415

Provider Business Practice Location Address
First Line	:	6006 49TH ST N
Second Line	:	STE 310
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2149
Country	:	US
Telephone Number	:	727-527-9779
Fax Number	:	727-522-0415

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MONIQUE PATRICK
Credential	:
Telephone Number	:	727-527-9779

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	05/09/2014

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