Healthcare Provider Details

I. General information

NPI: 1669563896
Provider Name (Legal Business Name): NEBRASKA-IOWA RADIOLOGY CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 S 84TH ST SUITE 2476
PAPILLION NE
68046-4122
US

IV. Provider business mailing address

11111 S 84TH ST SUITE 2476
PAPILLION NE
68046-4122
US

V. Phone/Fax

Practice location:
  • Phone: 403-339-8991
  • Fax:
Mailing address:
  • Phone: 403-339-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JON J BLEICHER
Title or Position: TREASURER
Credential: M.D.
Phone: 402-339-8991