Basic Information
| Provider Information | |||||||||
| NPI: | 1780635730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHUPBACH | ||||||||
| FirstName: | LANCE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6971 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685060971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024211811 | ||||||||
| FaxNumber: | 4024211833 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 S 16TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024751011 | ||||||||
| FaxNumber: | 4024814783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 01/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21885 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 21885 | NE | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 10024994600 | 05 | NE | MEDICAID | 03037818500 | 05 | NE | MEDICAID |