1770713539 NPI number — LINCOLN ANESTHESIOLOGY GROUP PC

Table of content: (NPI 1770713539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770713539 NPI number — LINCOLN ANESTHESIOLOGY GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN ANESTHESIOLOGY GROUP PC
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:
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:
1770713539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6067
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:
68506-0067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-434-5600
Provider Business Mailing Address Fax Number:
402-434-5601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 S 70TH ST STE 305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510-2471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-434-5600
Provider Business Practice Location Address Fax Number:
402-434-5601
Provider Enumeration Date:
07/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GLEASON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
402-434-5600

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  101097 , 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