=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306058425
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH PLATTE HEART INSTITUTE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1307 SOUTH OAK STREET
-----------------------------------------------------
City | NORTH PLATTE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-532-5522
-----------------------------------------------------
Fax | 308-534-7700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 82585
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68501-2585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-328-3048
-----------------------------------------------------
Fax | 402-328-3725
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. THOMAS W BURNELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-328-3048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------