=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831261957
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED CARDIOVASCULAR CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 05/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12717 S 28TH AVE STE B
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68123-3232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-502-3723
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12717 S 28TH AVE STE B
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68123-3232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-502-3723
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN JOSEPH CIMINO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 402-552-2800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 18713
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------