Provider Demographics
NPI:1760541288
Name:ALEGENT HEALTH NORTHWEST IMAGING CENTER LLC
Entity Type:Organization
Organization Name:ALEGENT HEALTH NORTHWEST IMAGING CENTER LLC
Other - Org Name:NORTHWEST IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HACHTEN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4420
Mailing Address - Street 1:3606 N 156TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2158
Mailing Address - Country:US
Mailing Address - Phone:402-717-1177
Mailing Address - Fax:402-717-1175
Practice Address - Street 1:3606 N 156TH ST
Practice Address - Street 2:SUITE 102-105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2158
Practice Address - Country:US
Practice Address - Phone:402-717-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07148OtherBCBS
NE10025463800Medicaid
NE=========OtherEIN
NE=========OtherEIN
NE10025463800Medicaid