Basic Information
| Provider Information | |||||||||
| NPI: | 1962408732 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | URGENT CARE CLINIC OF LINCOLN, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4210 PIONEER WOODS DR | ||||||||
| Address2: | STE A | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685067557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024884321 | ||||||||
| FaxNumber: | 4024884355 | ||||||||
| Practice Location | |||||||||
| Address1: | 4210 PIONEER WOODS DR | ||||||||
| Address2: | STE A | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685067557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024884321 | ||||||||
| FaxNumber: | 4024884355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 05/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | RICE | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | TROY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4024884321 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 10025271400 | 05 | NE | MEDICAID |