Provider Demographics
NPI:1205937356
Name:NORTH CENTRAL RADIOLOGY INC
Entity type:Organization
Organization Name:NORTH CENTRAL RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BEAUVAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-477-7013
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:YUTAN
Mailing Address - State:NE
Mailing Address - Zip Code:68073-0103
Mailing Address - Country:US
Mailing Address - Phone:866-477-7013
Mailing Address - Fax:866-902-2445
Practice Address - Street 1:4600 38TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1664
Practice Address - Country:US
Practice Address - Phone:402-564-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========13Medicaid