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2525 Pine Lake Road Practice Location 68512 Po 23048 68542 Lincoln NE 68542 | |
(402) 420-2094 | |
(402) 420-2095 |
Full Name | |
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Speciality | Clinic/center |
Location | 2525 Pine Lake Road Practice Location 68512, Lincoln, Nebraska |
Authorized Official Name and Position | Bette Grace Tucker (OPERATIONS MANAGER) |
Authorized Official Contact | 4024234739 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po 23048 Lincoln NE 68542 Ph: (402) 420-2094 | 2525 Pine Lake Road Practice Location 68512 Po 23048 68542 Lincoln NE 68542 Ph: (402) 420-2094 |
NPI Number | 1831252121 |
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Provider Enumeration Date | 12/18/2006 |
Last Update Date | 12/11/2009 |
Identifier | Type | State | Issuer |
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1831252121 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 219844341 (Nebraska) | Primary |
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