Healthcare Provider Details

I. General information

NPI: 1922020999
Provider Name (Legal Business Name): HEARTLAND VEIN AND VASCULAR INSTITUTE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12702 WESTPORT PKWY #101
OMAHA NE
68138-4012
US

IV. Provider business mailing address

12702 WESTPORT PKWY #101
OMAHA NE
68138-4012
US

V. Phone/Fax

Practice location:
  • Phone: 402-614-0026
  • Fax: 402-614-1877
Mailing address:
  • Phone: 402-614-0026
  • Fax: 402-614-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS B WHITTLE
Title or Position: M.D./PRESIDENT
Credential: M.D.
Phone: 402-614-0026