Provider Demographics
NPI:1154381713
Name:CARDIOPULMONARY SURGICAL CONSULTANTS PC
Entity type:Organization
Organization Name:CARDIOPULMONARY SURGICAL CONSULTANTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-929-7393
Mailing Address - Street 1:310 N STATE OF FRANKLIN RD
Mailing Address - Street 2:STE 101
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-929-7393
Mailing Address - Fax:423-929-1427
Practice Address - Street 1:310 N STATE OF FRANKLIN RD
Practice Address - Street 2:STE 101
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-929-7393
Practice Address - Fax:423-929-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3706826Medicaid
TN3706826Medicaid