Organization
RADIOLOGY IMAGING OF NEBRASKA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACEANN GRILLO (CREDENTIALING SUPERVISOR)
(720) 493-3716
Entity
Organization
Contact information
Practice address
4021 AVENUE B, SCOTTSBLUFF, NE 69361-4602
(308) 635-3711
(303) 630-1120
Mailing address
10800 E GEDDES AVE STE 300, ENGLEWOOD, CO 80112-3895
(303) 761-9190
(720) 874-4462
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025709000
—
NE
05
—
100262777-00
—
NE
05
—
100262778-00
—
NE
05
—
1184869901
—
IA
05
—
1184869901
—
MO
Enumeration date
12/08/2008
Last updated
03/31/2024
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