Provider Demographics
NPI:1407392350
Name:CENTRAL CARDIAC CARE PC
Entity Type:Organization
Organization Name:CENTRAL CARDIAC CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-507-0701
Mailing Address - Street 1:927 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2410
Mailing Address - Country:US
Mailing Address - Phone:402-834-2020
Mailing Address - Fax:402-834-2021
Practice Address - Street 1:2115 N KANSAS AVE
Practice Address - Street 2:SUITE102
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2640
Practice Address - Country:US
Practice Address - Phone:402-834-2020
Practice Address - Fax:402-834-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27641261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty