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General NPI Number Information
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NPI Number | 1215281662
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Entity Type | Organization
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Legal Business Name | NOT USED
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 11/09/2012
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Provider Practice Location Address
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Address Line | 3219 CENTRAL AVE STE 106
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City | KEARNEY
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State | NE
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Zip | 68847-2949
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Country | US
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Telephone | 308-865-2601
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Fax | 308-865-2829
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Provider Business Mailing Address
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Address Line | 3219 CENTRAL AVE STE 106
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City | KEARNEY
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State | NE
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Zip | 68847-2949
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Country | US
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Telephone | 308-865-2601
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Fax | 308-865-2829
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. Z Z
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Credential | MD
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Telephone | 308-865-2601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 19175
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License Number State | NE
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