1366434854 NPI number — HEARTLAND CARDIOLOGY PC

Table of content: (NPI 1366434854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366434854 NPI number — HEARTLAND CARDIOLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND CARDIOLOGY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366434854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8552 CASS ST
Provider Second Line Business Mailing Address:
#308
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68114-3570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-991-5300
Provider Business Mailing Address Fax Number:
402-991-5407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8552 CASS ST
Provider Second Line Business Practice Location Address:
#308
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-3570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-991-5300
Provider Business Practice Location Address Fax Number:
402-991-5407
Provider Enumeration Date:
08/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCLEAY
Authorized Official First Name:
PETER
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-991-5300

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  30071 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 18014 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0544817 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59814 . This is a "BC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 31944 . This is a "BC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 110145179 . This is a "RRMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2500216 . This is a "UHC" identifier . This identifiers is of the category "OTHER".




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