Provider Demographics
NPI:1922020999
Name:HEARTLAND VEIN AND VASCULAR INSTITUTE, P.C.
Entity Type:Organization
Organization Name:HEARTLAND VEIN AND VASCULAR INSTITUTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-614-0026
Mailing Address - Street 1:12702 WESTPORT PKWY
Mailing Address - Street 2:#101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-4012
Mailing Address - Country:US
Mailing Address - Phone:402-614-0026
Mailing Address - Fax:402-614-1877
Practice Address - Street 1:12702 WESTPORT PKWY
Practice Address - Street 2:#101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-4012
Practice Address - Country:US
Practice Address - Phone:402-614-0026
Practice Address - Fax:402-614-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDF9576OtherRRM
NE10025411200Medicaid
NE099884Medicare PIN