Provider Demographics
NPI:1306081625
Name:UNIVERSITY THORACIC SURGEONS
Entity type:Organization
Organization Name:UNIVERSITY THORACIC SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:312-738-3732
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 774
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-738-3732
Mailing Address - Fax:312-738-9763
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 774
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-738-3732
Practice Address - Fax:312-738-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital