Provider Demographics
NPI:1699972380
Name:CARDIOVASCULAR SURGICAL PROF LLC
Entity type:Organization
Organization Name:CARDIOVASCULAR SURGICAL PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-861-8158
Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-861-8158
Mailing Address - Fax:303-861-0939
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 5000
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-861-8158
Practice Address - Fax:303-861-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC808978Medicare PIN