Healthcare Provider Details

I. General information

NPI: 1376860155
Provider Name (Legal Business Name): HEART SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NORTH 103RD PLAZA SUITE 100
OMAHA NE
68114-1119
US

IV. Provider business mailing address

8601 W DODGE RD SUITE 216
OMAHA NE
68114-3495
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-5055
  • Fax:
Mailing address:
  • Phone: 402-354-4822
  • Fax: 402-354-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRAD L. HANSEN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 402-354-3778