| Pine Lake Health Llc | |
|
2611 S 70th St Lincoln NE 68506-2960 | |
| (402) 423-4200 | |
| (402) 423-4201 |
| Full Name | Pine Lake Health Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2611 S 70th St, Lincoln, Nebraska |
| Authorized Official Name and Position | Matthew M Glenn (PRESIDENT) |
| Authorized Official Contact | 4024234200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Lake Health Llc 2611 S 70th St Lincoln NE 68506-2960 Ph: (402) 423-4200 | Pine Lake Health Llc 2611 S 70th St Lincoln NE 68506-2960 Ph: (402) 423-4200 |
| NPI Number | 1417908666 |
|---|---|
| Provider Enumeration Date | 05/12/2006 |
| Last Update Date | 08/30/2022 |
| Medicare PECOS PAC ID | 1557372919 |
|---|---|
| Medicare Enrollment ID | O20060522000133 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417908666 | NPI | - | NPPES |
| 02800 | Other | NE | BCBS |
| 10025371800 | Medicaid | NE |
| Provider Name | Matthew M Glenn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225080419 PECOS PAC ID: 0244134880 Enrollment ID: I20031125000088 |
| Provider Name | Jacqueline A Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881827129 PECOS PAC ID: 3476694654 Enrollment ID: I20100111000093 |
| Provider Name | Alexandria A Arroyo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649705849 PECOS PAC ID: 6204108681 Enrollment ID: I20170818003021 |
| Provider Name | Linda Lee Kroeger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033188321 PECOS PAC ID: 3870634447 Enrollment ID: I20180503002204 |
| Provider Name | Alyson K Ferguson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952971822 PECOS PAC ID: 9931502895 Enrollment ID: I20211029000882 |
| Provider Name | Megan Louise Skradis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750911020 PECOS PAC ID: 8527449552 Enrollment ID: I20220721001518 |
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