Basic Information
| Provider Information | |||||||||
| NPI: | 1952359762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALVA | ||||||||
| FirstName: | ANNABEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14301 FNB PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681547200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027585233 | ||||||||
| FaxNumber: | 8889721672 | ||||||||
| Practice Location | |||||||||
| Address1: | 933 E PIERCE ST | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515034626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023615225 | ||||||||
| FaxNumber: | 4023911533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 34530 | IA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 21642 | NE | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 4548917 | 05 | IA | MEDICAID | 97054 | 01 | NE | WELLMARK | OTHER | 10025173600 | 05 | NE | MEDICAID | 1603163 | 01 | IA | UHC AMERICHOICE | OTHER | 1603184 | 01 | IA | UHC SHARE ADVANTAGE | OTHER | 22260 | 01 | IA | WELLMARK | OTHER | 236691 | 01 | NE | MIDLANDS CHOICE | OTHER |