Provider Demographics
NPI:1669563896
Name:NEBRASKA-IOWA RADIOLOGY CONSULTANTS, INC
Entity type:Organization
Organization Name:NEBRASKA-IOWA RADIOLOGY CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-339-8991
Mailing Address - Street 1:11111 S 84TH ST
Mailing Address - Street 2:SUITE 2476
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4122
Mailing Address - Country:US
Mailing Address - Phone:403-339-8991
Mailing Address - Fax:
Practice Address - Street 1:11111 S 84TH ST
Practice Address - Street 2:SUITE 2476
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4122
Practice Address - Country:US
Practice Address - Phone:403-339-8991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261QR0200X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2833OtherBLUE SHIELD
IA32784OtherBLUE SHIELD
IA180562Medicaid
IA180562Medicaid
IA180562Medicaid
IA32784Medicare PIN
NE=========13Medicaid
NE92289Medicare PIN