Basic Information
| Provider Information | |||||||||
| NPI: | 1164845202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIAGNOSTIC RADIOLOGY BELLEVUE OFFICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3521 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681030521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3086476444 | ||||||||
| FaxNumber: | 8669022445 | ||||||||
| Practice Location | |||||||||
| Address1: | 2510 BELLEVUE MEDICAL CENTER DR STE 145 | ||||||||
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| City: | BELLEVUE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681231556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3086476444 | ||||||||
| FaxNumber: | 8669022445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2014 | ||||||||
| LastUpdateDate: | 01/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | POHL | ||||||||
| AuthorizedOfficialFirstName: | JO | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3086476444 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DIAGNOSTIC RADIOLOGY PC | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
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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.