1457571663 NPI number — NORTHEAST NEBRASKA IMAGING CENTER, LLC

Table of content: (NPI 1457571663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457571663 NPI number — NORTHEAST NEBRASKA IMAGING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST NEBRASKA IMAGING CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457571663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 N 27TH ST
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68701-4457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-844-8187
Provider Business Mailing Address Fax Number:
402-844-8188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N 27TH ST
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68701-4457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-844-8187
Provider Business Practice Location Address Fax Number:
402-844-8188
Provider Enumeration Date:
04/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BELDEN
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
CONTRACTING SPECIALISTS
Authorized Official Telephone Number:
719-296-5840

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34402 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025509400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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