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Organization
COULEE DIAGNOSTIC RADIOLOGY INC
Active
Organization
COULEE DIAGNOSTIC RADIOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMANUEL OMOBA MD (MANAGING DIRECTOR)
(608) 518-3406
Entity
Organization
Contact information
Practice address
1580 HERITAGE BLVD, WEST SALEM, WI 54669-9418
(608) 518-3406
Mailing address
807 BARSON CT, ONALASKA, WI 54650-3603
(608) 518-3406
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32447500
—
WI
05
—
F37837
—
WI
Enumeration date
06/01/2020
Last updated
06/15/2020
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