Healthcare Provider Details

I. General information

NPI: 1174809982
Provider Name (Legal Business Name): SIMONMED IMAGING NEBRASKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 REGENCY PKWY STE 125
OMAHA NE
68114-3791
US

IV. Provider business mailing address

PO BOX 203545
DALLAS TX
75320-3545
US

V. Phone/Fax

Practice location:
  • Phone: 402-255-2700
  • Fax: 402-255-2701
Mailing address:
  • Phone: 888-685-3913
  • Fax: 800-508-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HOWARD JOHN SIMON
Title or Position: PRESIDENT
Credential: MD
Phone: 602-809-6623