Healthcare Provider Details

I. General information

NPI: 1073749172
Provider Name (Legal Business Name): OMAHA HEART HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8552 CASS ST SUITE 250
OMAHA NE
68114-3570
US

IV. Provider business mailing address

8552 CASS ST SUITE 308
OMAHA NE
68114-3570
US

V. Phone/Fax

Practice location:
  • Phone: 401-991-7166
  • Fax: 402-991-5407
Mailing address:
  • Phone: 402-991-5300
  • Fax: 402-991-5407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number StateNE

VIII. Authorized Official

Name: DR. PETER D MCLEAY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-991-7166