MEDICARE: THORACIC & CARDIOVASCULAR ASSOCIATES, PA

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	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B4461	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1891754586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THORACIC & CARDIOVASCULAR ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	2750 LAUREL ST
Second Line	:	SUITE 305
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2038
Country	:	US
Telephone Number	:	803-254-5140
Fax Number	:	803-779-1279

Provider Business Practice Location Address
First Line	:	2750 LAUREL ST
Second Line	:	SUITE 305
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2038
Country	:	US
Telephone Number	:	803-254-5140
Fax Number	:	803-779-1279

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN P SUTTON
Credential	:	MD
Telephone Number	:	803-254-5140

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	01/02/2015

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