Provider Demographics
NPI:1306874482
Name:CARDIOTHORACIC SURGEONS FOR NW OHIO, INC.
Entity type:Organization
Organization Name:CARDIOTHORACIC SURGEONS FOR NW OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHYRN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-291-2077
Mailing Address - Street 1:2109 HUGHES DR STE 720
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-5110
Mailing Address - Country:US
Mailing Address - Phone:419-291-2077
Mailing Address - Fax:419-291-2122
Practice Address - Street 1:2109 HUGHES DR STE 720
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-5110
Practice Address - Country:US
Practice Address - Phone:419-291-2077
Practice Address - Fax:419-291-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2079192Medicaid
OH9299331Medicare PIN