Provider Demographics
NPI:1760402507
Name:OMAHA CARDIAC SURGERY, P.C.
Entity Type:Organization
Organization Name:OMAHA CARDIAC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEETZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:402-827-5500
Mailing Address - Street 1:7710 MERCY RD
Mailing Address - Street 2:SUITE 332
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2372
Mailing Address - Country:US
Mailing Address - Phone:402-827-5500
Mailing Address - Fax:402-827-6601
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:SUITE 332
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2372
Practice Address - Country:US
Practice Address - Phone:402-827-5500
Practice Address - Fax:402-827-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13128208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099768Medicare ID - Type Unspecified