Provider Demographics
NPI:1043284094
Name:CARDIOVASCULAR ASSOCIATES PC
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-239-4702
Mailing Address - Street 1:5885 SUNNYBROOK DRIVE
Mailing Address - Street 2:SUITE L-200
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106
Mailing Address - Country:US
Mailing Address - Phone:712-239-4702
Mailing Address - Fax:712-224-5898
Practice Address - Street 1:5885 SUNNYBROOK DRIVE
Practice Address - Street 2:SUITE L-200
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106
Practice Address - Country:US
Practice Address - Phone:712-239-4702
Practice Address - Fax:712-224-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41203Medicare PIN
NE098670Medicare PIN
IA41195Medicare PIN
IA41198Medicare PIN
IA41205Medicare PIN
IA41190Medicare PIN
IA41197Medicare PIN
IA41199Medicare PIN
IA42827Medicare PIN
IA41192Medicare PIN
IA41194Medicare PIN
IA41202Medicare PIN
IA41020Medicare PIN
IA41191Medicare PIN
IA41193Medicare PIN
IA41196Medicare PIN
IA41189Medicare PIN
IA41200Medicare PIN
IA41201Medicare PIN
IA41204Medicare PIN
IA41192Medicare PIN