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ILLINOIS CARDIOVASCULAR & THORACIC SURGERY LTD NPI 1962450734


NPI Information

NPI: 1962450734
Provider Name: ILLINOIS CARDIOVASCULAR & THORACIC SURGERY, LTD
Classification: Thoracic Surgery (Cardiothoracic Vascular Surgery) - 208G00000X
Entity Type: Organization

CLIA Number: 14D2209090

Address:
1505 EASTLAND DR
SUITE 210
BLOOMINGTON, IL
ZIP 61701
Phone: (309) 662-5506
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ILLINOIS CARDIOVASCULAR & THORACIC SURGERY, LTD is a thoracic surgery cardiothoracic vascular surgery in Bloomington, IL. The provider is a thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. ILLINOIS CARDIOVASCULAR & THORACIC SURGERY, LTD NPI is 1962450734. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1505 EASTLAND DR
SUITE 210
BLOOMINGTON, IL
ZIP 61701-906
Phone: (309) 662-5506
Fax: (309) 662-5443

The provider's authorized official is Glen B Smith .
The authorized official title is Chiref Operations Officer and has the following contact phone number (309) 662-5506.

The CLIA number assigned to this NPI record is 14D2209090 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/4/2006 and was last updated on 4/24/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RC0000XInternal MedicineCardiovascular DiseaseNo
2207RI0011XInternal MedicineInterventional CardiologyNo
3207UN0901XNuclear MedicineNuclear CardiologyNo
42085R0204XRadiologyVascular & Interventional RadiologyNo
5363A00000XPhysician AssistantNo
6208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1CK7113MEDICARE ID-TYPE UNSPECIFIEDRAILROAD MEDICARE GROUP
2204814MEDICARE ID-TYPE UNSPECIFIEDILLINOISMEDICARE GROUP NUMBER
3204815MEDICARE ID-TYPE UNSPECIFIEDILLINOISMEDICARE GROUP NUMBER
405732036OTHERILLINOISBLUE SHIELD GROUP NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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