| |
7120 S. 69th Street Suite 101a Lincoln NE 68516 | |
(402) 499-2883 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 7120 S. 69th Street, Lincoln, Nebraska |
Authorized Official Name and Position | Lisa Johnson (OFFICE MANAGER/PROVIDER/CO-OWNER) |
Authorized Official Contact | 4024992883 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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15877 S 64th St Roca NE 68430-4355 Ph: (402) 340-2505 | 7120 S. 69th Street Suite 101a Lincoln NE 68516 Ph: (402) 499-2883 |
NPI Number | 1346940210 |
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Provider Enumeration Date | 03/08/2023 |
Last Update Date | 09/16/2024 |
Medicare PECOS PAC ID | 0345696589 |
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Medicare Enrollment ID | O20231025001069 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346940210 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
Provider Name | Jay R Meyer |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1487665899 PECOS PAC ID: 1254376346 Enrollment ID: I20050620000738 |
Provider Name | Kelly A Fields |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306828181 PECOS PAC ID: 0840315131 Enrollment ID: I20100909000856 |
Provider Name | Heather Talbott |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1144745761 PECOS PAC ID: 6204178445 Enrollment ID: I20190508001874 |
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