Provider Demographics
NPI:1881614709
Name:MIDAMERICA CARDIOVASCULAR INSTITUTE P.C.
Entity type:Organization
Organization Name:MIDAMERICA CARDIOVASCULAR INSTITUTE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAZQUEZ-BAUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-393-8443
Mailing Address - Street 1:8552 CASS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3570
Mailing Address - Country:US
Mailing Address - Phone:402-393-8443
Mailing Address - Fax:402-393-8677
Practice Address - Street 1:8552 CASS ST STE 201
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3570
Practice Address - Country:US
Practice Address - Phone:402-393-8443
Practice Address - Fax:402-393-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19943207R00000X
NE20956207RC0000X
NE110706363LA2200X
NE110198363LF0000X
NE19950207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024986600Medicaid
NE10024986800Medicaid
NEC82771Medicare UPIN
NEF44728Medicare UPIN
NE10024986800Medicaid
NEQ49423Medicare UPIN
NES66506Medicare UPIN
NEG19533Medicare UPIN