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NPI Code Detail

MEDICARE: CENTRAL COAST CARDIOTHORACIC SURGICAL ASSOCIATES-A MEDICAL GROUP

MEDICARE: CENTRAL COAST CARDIOTHORACIC SURGICAL ASSOCIATES-A MEDICAL GROUP
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
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Other Identifiers

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

General Provider Information

NPI Number : 1871527838
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL COAST CARDIOTHORACIC SURGICAL ASSOCIATES-A MEDICAL GROUP
Provider Business Mailing Address
First Line : 911 OAK PARK BLVD
Second Line : STE 102
City : PISMO BEACH
State : CA
Zip : 93449-3405
Country : US
Telephone Number : 805-556-6001
Fax Number : 805-773-4232
Provider Business Practice Location Address
First Line : 911 OAK PARK BLVD
Second Line : STE 102
City : PISMO BEACH
State : CA
Zip : 93449-3405
Country : US
Telephone Number : 805-556-6001
Fax Number : 805-773-4232
Authorized Official
Title or Position : OFFICE MANAGER
Name : MS. LISA M KENT
Credential :
Telephone Number : 805-556-6001
Provider Enumeration Date : 07/10/2006
Last Update Date : 03/01/2017

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Directions to “CENTRAL COAST CARDIOTHORACIC SURGICAL ASSOCIATES-A MEDICAL GROUP ” Practice Location

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