Healthcare Provider Details

I. General information

NPI: 1558443028
Provider Name (Legal Business Name): NEBRASKA ADVANCED RADIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 NORTH 32ND AVENUE SUITE 100
OMAHA NE
68131-2505
US

IV. Provider business mailing address

117 NORTH 32ND AVENUE SUITE 100
OMAHA NE
68131-2505
US

V. Phone/Fax

Practice location:
  • Phone: 402-715-5200
  • Fax: 402-715-5201
Mailing address:
  • Phone: 402-715-5200
  • Fax: 402-715-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. ROBIN S NELSON
Title or Position: MANAGER
Credential: R.T.(R)(M)(CT)
Phone: 402-715-5200