Healthcare Provider Details

I. General information

NPI: 1164845202
Provider Name (Legal Business Name): DIAGNOSTIC RADIOLOGY BELLEVUE OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2014
Last Update Date: 01/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 BELLEVUE MEDICAL CENTER DR STE 145
BELLEVUE NE
68123-1556
US

IV. Provider business mailing address

PO BOX 3521
OMAHA NE
68103-0521
US

V. Phone/Fax

Practice location:
  • Phone: 308-647-6444
  • Fax: 866-902-2445
Mailing address:
  • Phone: 308-647-6444
  • Fax: 866-902-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JO A POHL
Title or Position: MANAGER
Credential: CPC
Phone: 308-647-6444