| Coddington Medical Family Practice | |
|
1336 West A Street, Suite A Lincoln NE 68522 | |
| (402) 742-2502 | |
| Not Available |
| Full Name | Coddington Medical Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 1336 West A Street, Suite A, Lincoln, Nebraska |
| Authorized Official Name and Position | Timothy J Sullivan (PRESIDENT) |
| Authorized Official Contact | 4027422502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coddington Medical Family Practice 7711 W Walin Ln Lincoln NE 68532-9200 Ph: (402) 742-2502 | Coddington Medical Family Practice 1336 West A Street, Suite A Lincoln NE 68522 Ph: (402) 742-2502 |
| NPI Number | 1205264231 |
|---|---|
| Provider Enumeration Date | 10/30/2013 |
| Last Update Date | 10/30/2013 |
| Medicare PECOS PAC ID | 5991936841 |
|---|---|
| Medicare Enrollment ID | O20140319000099 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205264231 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 17443 (Nebraska) | Primary |
| Provider Name | Timothy J Sullivan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376524611 PECOS PAC ID: 8527098870 Enrollment ID: I20100511000916 |
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