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General NPI Number Information
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NPI Number | 1407392350
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Entity Type | Organization
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Legal Business Name | CENTRAL CARDIAC CARE PC
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 2115 N KANSAS AVE SUITE102
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City | HASTINGS
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State | NE
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Zip | 68901-2640
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Country | US
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Telephone | 402-834-2020
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Fax | 402-834-2021
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Provider Business Mailing Address
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Address Line | 927 HIGHLAND DR
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City | HASTINGS
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State | NE
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Zip | 68901-2410
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Country | US
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Telephone | 402-834-2020
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Fax | 402-834-2021
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Authorized Official
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Title or Position | OWNER
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Name | MUKESH GARG
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Credential | MD
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Telephone | 816-507-0701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 27641
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License Number State | NE
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