Provider Demographics
NPI:1104961614
Name:MEDICAL IMAGING CONSULTANTS, P. C.
Entity type:Organization
Organization Name:MEDICAL IMAGING CONSULTANTS, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAULK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-592-0711
Mailing Address - Street 1:7950 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2912
Mailing Address - Country:US
Mailing Address - Phone:402-592-0711
Mailing Address - Fax:402-934-9242
Practice Address - Street 1:7950 HARRISON ST
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-2912
Practice Address - Country:US
Practice Address - Phone:402-592-0711
Practice Address - Fax:402-934-9242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NEE41152Medicare UPIN
NE=========13Medicaid