Healthcare Provider Details

I. General information

NPI: 1366475758
Provider Name (Legal Business Name): NEBRASKA INTENSITY MODULATED RADIOTHERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 06/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 EIGER DR
LINCOLN NE
68516-6537
US

IV. Provider business mailing address

PO BOX 6951
LINCOLN NE
68506-0951
US

V. Phone/Fax

Practice location:
  • Phone: 402-904-7135
  • Fax: 402-904-7175
Mailing address:
  • Phone: 402-904-7135
  • Fax: 402-904-7175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENNETT R BARRIOS
Title or Position: PRESIDENT
Credential: MD
Phone: 402-904-7135