Healthcare Provider Details

I. General information

NPI: 1336125202
Provider Name (Legal Business Name): NEBRASKA HEART INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 SOUTH 91ST STREET
LINCOLN NE
68526-9797
US

IV. Provider business mailing address

PO BOX 82585
LINCOLN NE
68501-2585
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-6555
  • Fax: 402-328-3989
Mailing address:
  • Phone: 402-489-6555
  • Fax: 402-328-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARLIN AUSDEMORE
Title or Position: CONTROLLER
Credential:
Phone: 402-328-3721