1679577605 NPI number — DIALYSIS CENTER OF LINCOLN, INC

Table of content: (NPI 1679577605)

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:
Provider Other Organization Name Type Code:
6
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)





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