Healthcare Provider Details

I. General information

NPI: 1952661654
Provider Name (Legal Business Name): CENTRAL NEBRASKA CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 CENTRAL AVE SUITE 107
KEARNEY NE
68847-2949
US

IV. Provider business mailing address

3219 CENTRAL AVE 3219 CENTAL AVE; SUITE 107
KEARNEY NE
68847-2949
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-1419
  • Fax: 308-865-2829
Mailing address:
  • Phone: 308-440-7200
  • Fax: 308-865-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number19175
License Number StateNE

VIII. Authorized Official

Name: DR. DANIEL J MCGOWAN
Title or Position: OWNER
Credential: M.D.
Phone: 308-440-7200