Provider Demographics
NPI:1174809982
Name:SIMONMED IMAGING NEBRASKA LLC
Entity type:Organization
Organization Name:SIMONMED IMAGING NEBRASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-809-6623
Mailing Address - Street 1:PO BOX 203545
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-3545
Mailing Address - Country:US
Mailing Address - Phone:888-685-3913
Mailing Address - Fax:800-508-4751
Practice Address - Street 1:310 REGENCY PKWY
Practice Address - Street 2:STE 125
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3791
Practice Address - Country:US
Practice Address - Phone:402-255-2700
Practice Address - Fax:402-255-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2065Medicare PIN