Provider Demographics
NPI:1700078854
Name:NORTHEAST NEBRASKA CARDIOLOGY CONSULTANTS P C
Entity Type:Organization
Organization Name:NORTHEAST NEBRASKA CARDIOLOGY CONSULTANTS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-644-4411
Mailing Address - Street 1:109 N 29TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3261
Mailing Address - Country:US
Mailing Address - Phone:402-644-4411
Mailing Address - Fax:402-644-4422
Practice Address - Street 1:109 N 29TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3261
Practice Address - Country:US
Practice Address - Phone:402-644-4411
Practice Address - Fax:402-644-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE099235Medicare PIN