Provider Demographics
NPI:1497713291
Name:DIAGNOSTIC RADIOLOGY PC
Entity Type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-493-1212
Mailing Address - Street 1:14301 FNB PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-7200
Mailing Address - Country:US
Mailing Address - Phone:402-493-1212
Mailing Address - Fax:888-972-1672
Practice Address - Street 1:14301 FNB PKWY STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-7200
Practice Address - Country:US
Practice Address - Phone:402-493-1212
Practice Address - Fax:888-972-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE90622OtherWELLMARK BC/BS
NE10025173600Medicaid
IA38457OtherWELLMARK BC/BS
NE10025173600Medicaid
IA38457OtherWELLMARK BC/BS
IADC6546Medicare PIN
NE099580Medicare PIN