Provider Demographics
NPI:1174608871
Name:THORACIC & CARDIOVASCULAR ASSOCIATES OF TUSCALOOSA PC
Entity type:Organization
Organization Name:THORACIC & CARDIOVASCULAR ASSOCIATES OF TUSCALOOSA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-759-4228
Mailing Address - Street 1:701 UNIVERSITY BLVD EAST
Mailing Address - Street 2:DCH MEDICAL TOWER SUITE 602
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401
Mailing Address - Country:US
Mailing Address - Phone:205-759-4228
Mailing Address - Fax:205-345-0841
Practice Address - Street 1:701 UNIVERSITY BLVD EAST
Practice Address - Street 2:DCH MEDICAL TOWER SUITE 602
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401
Practice Address - Country:US
Practice Address - Phone:205-759-4228
Practice Address - Fax:205-345-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD543Medicare PIN