Provider Demographics
NPI:1962693721
Name:THORACIC AND CARDIOVASCULAR SURGERY INC
Entity type:Organization
Organization Name:THORACIC AND CARDIOVASCULAR SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TISHKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-575-8500
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-0650
Mailing Address - Country:US
Mailing Address - Phone:614-575-8500
Mailing Address - Fax:614-575-8500
Practice Address - Street 1:6275 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1504
Practice Address - Country:US
Practice Address - Phone:614-575-8500
Practice Address - Fax:614-575-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054319T208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0922238Medicaid
OH9348171Medicare UPIN