Provider Demographics
NPI:1457571663
Name:NORTHEAST NEBRASKA IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:NORTHEAST NEBRASKA IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING SPECIALISTS
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-296-5840
Mailing Address - Street 1:301 N 27TH ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4457
Mailing Address - Country:US
Mailing Address - Phone:402-844-8187
Mailing Address - Fax:402-844-8188
Practice Address - Street 1:301 N 27TH ST
Practice Address - Street 2:SUITE 15
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4457
Practice Address - Country:US
Practice Address - Phone:402-844-8187
Practice Address - Fax:402-844-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE34402OtherBCBS
NE10025509400Medicaid
NE34402OtherBCBS