Provider Demographics
NPI:1043526080
Name:FREMONT HEALTH
Entity Type:Organization
Organization Name:FREMONT HEALTH
Other - Org Name:FREMONT CARDIOVASCULAR SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-721-1610
Mailing Address - Street 1:426 E 22ND STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2633
Mailing Address - Country:US
Mailing Address - Phone:402-727-7796
Mailing Address - Fax:402-727-9574
Practice Address - Street 1:426 EAST 22ND STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2633
Practice Address - Country:US
Practice Address - Phone:402-727-7796
Practice Address - Fax:402-727-9574
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREMONT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-27
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1721Medicare PIN