=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174185607
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VINAYAK NAGARAJA MBBS MS MMED FRACP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2019
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 816 22ND AVE STE 100
-----------------------------------------------------
City | KEARNEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68845-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-865-2263
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 816 22ND AVE STE 100
-----------------------------------------------------
City | KEARNEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68845-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-865-2263
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 35.140395
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | CP1119
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 68200
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 77864-20
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------