1679577605 NPI number — DIALYSIS CENTER OF LINCOLN, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679577605 NPI number — DIALYSIS CENTER OF LINCOLN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIALYSIS CENTER OF LINCOLN, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIALYSIS CENTER OF COLUMBUS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679577605
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7910 O ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68510-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-489-5339
Provider Business Mailing Address Fax Number:
402-489-7366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2452 39TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68601-2255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-563-2139
Provider Business Practice Location Address Fax Number:
402-563-9145
Provider Enumeration Date:
06/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EMERSON
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
402-489-5339

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  ESRD020 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com