Basic Information
| Provider Information | |||||||||
| NPI: | 1528028628 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOLMES LAKE FAMILY HEALTH CENTRE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6900 VAN DORN ST | ||||||||
| Address2: | SUITE 24 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685062882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024893200 | ||||||||
| FaxNumber: | 4024895101 | ||||||||
| Practice Location | |||||||||
| Address1: | 6900 VAN DORN ST | ||||||||
| Address2: | SUITE 24 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685062882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024893200 | ||||||||
| FaxNumber: | 4024895101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHNEIDER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4024893200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.