MIDWEST MEDICAL IMAGING CENTER INC (NPI# 1902975386) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902975386 |
| Entity Type | Organization |
| Organization Name | MIDWEST MEDICAL IMAGING CENTER INC |
| Practice Address |
Midwest Medical Imaging Center 6901 North 72nd Street Omaha NE 68122 |
| Mailing Address |
1715 Deer Tracks Trl Saint Louis MO 63131-1839 |
| Practice Telephone | 4025723131 |
| Practice Fax Number | 4025723661 |
| Mailing Telephone | 3148215600 |
| Mailing Fax Number | 3148212189 |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | THOMAS S FORREST (PRESIDENT) |
| Authorized Official Telephone | 4025723131 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
NE | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0231183 | 05 |
| Street Address |
MIDWEST MEDICAL IMAGING CENTER 6901 NORTH 72ND STREET |
| City | OMAHA |
| State | NE |
| Zip Code | 68122 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609282920 | Andre Jordan | Registered Nurse | 7215 N. 90th Street, Omaha, NE 68122 | 2014-07-08 |
| 1063748895 | Amy Kristine Jones | Speech-Language Pathologist | 703 Country View Dr, Champaign, IL 68122 | 2009-10-29 |
| 1992964100 | Alegent Health Immanuel Medical Center | Psychiatric Residential Treatment Facility | 6845 N 68th Plaza, Omaha, NE 68122 | 2008-06-03 |
| 1093835852 | Suzane Lynne Bohlen | Nurse Anesthetist, Certified Registered | 6901 N 72 St, Omaha, NE 68122 | 2007-03-29 |
| 1376686733 | Midwest Surgical Associates PC | Surgery | 6828 N 72 St, #5500, Omaha, NE 68122 | 2007-02-15 |
| 1245348754 | Scott Denman Wilt | Anesthesiology | 6901 N 72 Street, Omaha, NE 68122 | 2006-08-25 |
| 1982620639 | Robert J Zadalis | Surgery | 6829 N 72nd St Ste 5500, Omaha, NE 68122 | 2006-07-14 |
| 1245299304 | Kristin Nicole Krobot | Physician Assistant | 6901 N. 72nd St., Immanuel Emergency Room, Omaha, NE 68122 | 2006-03-18 |
| 1326575440 | Kathleen L Koeppel | Registered Nurse | 6901 N 72nd Street, Attn: Diabetic Education, Omaha, NE 68122 | 2017-05-19 |
| 1477008571 | Rabie Emsalem | Internal Medicine | 6901 N 72nd St, Omaha, NE 68122 | 2016-08-18 |
| Find all providers in zip 68122 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104319664 | Jackson Wyatt Boice | Radiology | S 42nd St and Emile St, Omaha, NE 68198-8500 | 2018-06-10 |
| 1396163135 | Bijal Shah | Radiology | S 42nd St & Emile St, Omaha, NE 68198-0001 | 2014-03-30 |
| 1417198995 | Guy Neil Gibson | Radiology | 905 S 110th Plz, Omaha, NE 68154-3370 | 2009-03-13 |
| 1235312257 | James F Johnson | Radiology | 9847 Bloomfield Dr, Omaha, NE 68114-2117 | 2007-12-12 |
| 1114126802 | Julie Ann Ratino | Radiology | 301 N. 60th Street, Omaha, NE 68131 | 2007-07-13 |
| 1700088028 | Matthew Mendlick | Radiology | 16116 Bedford Ave, Omaha, NE 68116-6433 | 2007-05-31 |
| 1700095452 | Roger Kent Harned | Radiology | 12624 Martha St, Omaha, NE 68144-2626 | 2007-05-21 |
| 1740492230 | Melissa Nicole Manzer | Radiology | 981045 Nebraska Medical Center, Omaha, NE 68198-1045 | 2007-05-04 |
| 1740407618 | Lyudmila M Muinov | Radiology | 42nd and Emile St, Omaha, NE 68198 | 2007-04-19 |
| 1003921123 | Mary S. Davey | Radiology | 601 N 30th St Ste 3601, Omaha, NE 68131-2137 | 2006-08-20 |
| Find all providers in OMAHA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.