Provider Demographics
NPI:1083740898
Name:BLUFFS IMAGING ASSOCIATES
Entity Type:Organization
Organization Name:BLUFFS IMAGING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRANZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-325-8415
Mailing Address - Street 1:1414 AVE J
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-1167
Mailing Address - Country:US
Mailing Address - Phone:712-325-8415
Mailing Address - Fax:
Practice Address - Street 1:1414 AVE J
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-1167
Practice Address - Country:US
Practice Address - Phone:800-977-8795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29757174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0147017Medicaid
NE165159Medicaid
IAF74960Medicare UPIN
NEF74960Medicare UPIN
NE165159Medicaid