Provider Demographics
NPI:1558443028
Name:NEBRASKA ADVANCED RADIOLOGY, LLC
Entity Type:Organization
Organization Name:NEBRASKA ADVANCED RADIOLOGY, LLC
Other - Org Name:MOLECULAR DIAGNOSTICS OF EASTERN OMAHA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)(M)(CT)
Authorized Official - Phone:402-715-5200
Mailing Address - Street 1:117 NORTH 32ND AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2505
Mailing Address - Country:US
Mailing Address - Phone:402-715-5200
Mailing Address - Fax:402-715-5201
Practice Address - Street 1:117 NORTH 32ND AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2505
Practice Address - Country:US
Practice Address - Phone:402-715-5200
Practice Address - Fax:402-715-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025469000Medicaid
IA1558448028Medicaid
NE10025469000Medicaid
099894Medicare PIN