Provider Demographics
NPI:1366475758
Name:NEBRASKA INTENSITY MODULATED RADIOTHERAPY PC
Entity Type:Organization
Organization Name:NEBRASKA INTENSITY MODULATED RADIOTHERAPY PC
Other - Org Name:RADIATION ONCOLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-904-7135
Mailing Address - Street 1:PO BOX 6951
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0951
Mailing Address - Country:US
Mailing Address - Phone:402-904-7135
Mailing Address - Fax:402-904-7175
Practice Address - Street 1:8001 EIGER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6537
Practice Address - Country:US
Practice Address - Phone:402-904-7135
Practice Address - Fax:402-904-7175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDD3654OtherRAILROAD MEDICARE
NE10025202600Medicaid
NE10025202600Medicaid