Healthcare Provider Details

I. General information

NPI: 1104961614
Provider Name (Legal Business Name): MEDICAL IMAGING CONSULTANTS, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 HARRISON ST
LA VISTA NE
68128-2912
US

IV. Provider business mailing address

7950 HARRISON ST
LA VISTA NE
68128-2912
US

V. Phone/Fax

Practice location:
  • Phone: 402-592-0711
  • Fax: 402-934-9242
Mailing address:
  • Phone: 402-592-0711
  • Fax: 402-934-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROBERT M FAULK
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 402-592-0711