Basic Information
| Provider Information | |||||||||
| NPI: | 1023255643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUPERIOR MEDICAL IMAGING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7601 PIONEERS BLVD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685064675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024846677 | ||||||||
| FaxNumber: | 4024844476 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 N 26TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685214749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024846677 | ||||||||
| FaxNumber: | 4024844475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2009 | ||||||||
| LastUpdateDate: | 06/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | DEWALD | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 4024846677 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.