Basic Information
| Provider Information | |||||||||
| NPI: | 1639479363 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LINCOLN PHYSICIAN NETWORK LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 Q ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685033609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024210904 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3910 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685164783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024347383 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2010 | ||||||||
| LastUpdateDate: | 03/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | RECKEWEY | ||||||||
| AuthorizedOfficialFirstName: | REX | ||||||||
| AuthorizedOfficialMiddleName: | KENT | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4024210896 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE PHYSICIAN NETWORK | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.