Organization
LAWNWOOD CARDIOVASCULAR SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM TEDRICK JOHNSON (VICE PRESIDENT)
(615) 372-3375
Entity
Organization
Contact information
Practice address
2100 NEBRASKA AVE STE 201, FORT PIERCE, FL 34950-4832
(772) 465-8100
(772) 465-8689
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4525
(615) 372-5426
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG0823
RAILROAD MEDICARE
FL
Enumeration date
10/16/2006
Last updated
11/01/2022
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