MEDICARE: PROFESSIONAL MEDICAL IMAGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1598944795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL MEDICAL IMAGING LLC

Provider Business Mailing Address
First Line	:	301 N COTNER BLVD
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-2315
Country	:	US
Telephone Number	:	402-202-4723
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 N COTNER BLVD
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-2315
Country	:	US
Telephone Number	:	402-202-4723
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIKE RAASCH
Credential	:
Telephone Number	:	402-202-4723

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	10/24/2007

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