Provider Demographics
NPI:1053373746
Name:FLAGSHIP CARDIAC VASCULAR AND THORACIC SURGERY OF ERIE, PC
Entity type:Organization
Organization Name:FLAGSHIP CARDIAC VASCULAR AND THORACIC SURGERY OF ERIE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:FELLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-453-6751
Mailing Address - Street 1:120 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1537
Mailing Address - Country:US
Mailing Address - Phone:814-453-6751
Mailing Address - Fax:
Practice Address - Street 1:120 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1537
Practice Address - Country:US
Practice Address - Phone:814-453-6751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACA2015OtherRAILROAD MEDICARE
PAF82026Medicare UPIN
PAG63280Medicare UPIN
PAC33444Medicare UPIN
PAG45575Medicare UPIN
PACA2015OtherRAILROAD MEDICARE
PAC32995Medicare UPIN
PAG01231Medicare UPIN
PAG51594Medicare UPIN