Southport Cardiovascular Surgeons LLC

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

38886 Issued in WI

Legal business name

SOUTHPORT CARDIOVASCULAR SURGEONS LLC

Practice address

7137 236TH Avenue
#103
Paddock Lake, WI 53168

Phone

(262) 843-4422

NPI assigned

Jun 18, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Christopher Stone, MD

Title

Owner

Phone

(262) 843-4422

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434585600000",
    "number": "1063894723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7137 236TH AVENUE",
            "address_2": "#103",
            "city": "PADDOCK LAKE",
            "state": "WI",
            "postal_code": "53168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7137 236TH AVENUE",
            "address_2": "#103",
            "city": "PADDOCK LAKE",
            "state": "WI",
            "postal_code": "53168",
            "telephone_number": "262-843-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPORT CARDIOVASCULAR SURGEONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-18",
        "last_updated": "2015-06-18",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-843-4422",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "WI",
            "license": "38886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Paddock Lake, WI
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.