Provider Demographics
NPI:1669483459
Name:MIDLANDS CARDIOLOGY GROUP, PC
Entity Type:Organization
Organization Name:MIDLANDS CARDIOLOGY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:CK
Authorized Official - Last Name:KUTTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-865-7271
Mailing Address - Street 1:3015 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3525
Mailing Address - Country:US
Mailing Address - Phone:308-865-7271
Mailing Address - Fax:308-865-2045
Practice Address - Street 1:3015 AVENUE A
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3525
Practice Address - Country:US
Practice Address - Phone:308-865-7271
Practice Address - Fax:308-865-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========13Medicaid
NE098835Medicare ID - Type UnspecifiedGROUP MEDICARE NE NUMBER