Provider Demographics
NPI:1164845202
Name:DIAGNOSTIC RADIOLOGY BELLEVUE OFFICE
Entity Type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY BELLEVUE OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:A
Authorized Official - Last Name:POHL
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:308-647-6444
Mailing Address - Street 1:PO BOX 3521
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0521
Mailing Address - Country:US
Mailing Address - Phone:308-647-6444
Mailing Address - Fax:866-902-2445
Practice Address - Street 1:2510 BELLEVUE MEDICAL CENTER DR STE 145
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1556
Practice Address - Country:US
Practice Address - Phone:308-647-6444
Practice Address - Fax:866-902-2445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAGNOSTIC RADIOLOGY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-26
Last Update Date:2014-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty