Provider Demographics
NPI:1811289382
Name:PROVIDENCE CARDIOVASCULAR & THORACIC SURGERY, LLC
Entity type:Organization
Organization Name:PROVIDENCE CARDIOVASCULAR & THORACIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SUTTON, III
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-254-5140
Mailing Address - Street 1:2435 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2026
Mailing Address - Country:US
Mailing Address - Phone:803-254-5140
Mailing Address - Fax:803-779-1279
Practice Address - Street 1:2435 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2026
Practice Address - Country:US
Practice Address - Phone:803-254-5140
Practice Address - Fax:803-779-1279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SISTERS OF CHARITY PROFVIDENCE HOSPITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-03
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty