Healthcare Provider Details

I. General information

NPI: 1619390754
Provider Name (Legal Business Name): DIAGNOSTIC RADIOLOGY PC VEIN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2014
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16929 FRANCES ST STE 204
OMAHA NE
68130
US

IV. Provider business mailing address

PO BOX 3521
OMAHA NE
68103-0521
US

V. Phone/Fax

Practice location:
  • Phone: 402-758-5233
  • Fax: 402-884-9960
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:
Phone: 308-647-6444