Provider Demographics
NPI:1831261957
Name:ADVANCED CARDIOVASCULAR CARE PC
Entity type:Organization
Organization Name:ADVANCED CARDIOVASCULAR CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CIMINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-552-2800
Mailing Address - Street 1:12717 S 28TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-3232
Mailing Address - Country:US
Mailing Address - Phone:402-502-3723
Mailing Address - Fax:
Practice Address - Street 1:12717 S 28TH AVE STE B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-3232
Practice Address - Country:US
Practice Address - Phone:402-502-3723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18713207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE18713OtherSTATE LICENSE #
IA34442OtherIOWA LICENSE #
IA0553750Medicaid
IA34442OtherIOWA LICENSE #
IAI0567Medicare PIN
NE098945Medicare PIN
E78562Medicare UPIN