# DIAGNOSTIC RADIOLOGY PC VEIN CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DIAGNOSTIC RADIOLOGY PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1144650938
- **Legal business name:** DIAGNOSTIC RADIOLOGY PC
- **Authorized official:** JO A POHL CPC (BILLING MANAGER)
- **Authorized official phone:** (308) 647-6444

## Contact information

- **Practice address:** 26136 US HIGHWAY 59, FAIRFAX, MO 64446-9105
- **Practice address phone:** (308) 647-6444
- **Practice address fax:** (866) 902-2445
- **Mailing address:** PO BOX 3521, OMAHA, NE 68103-0521
- **Mailing address phone:** (308) 647-6444
- **Mailing address fax:** (866) 902-2445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | Yes |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/15/2013
- **Last updated:** 11/15/2013