Wedgewood Legacy Medical P.c. | |
8055 O St Ste S-109 Lincoln NE 68510-2564 | |
(402) 489-8821 | |
(402) 489-0733 |
Full Name | Wedgewood Legacy Medical P.c. |
---|---|
Speciality | Internal Medicine |
Location | 8055 O St, Lincoln, Nebraska |
Authorized Official Name and Position | James A. Fosnaugh (MD) |
Authorized Official Contact | 4024890334 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Wedgewood Legacy Medical P.c. 8055 O St Ste S-109 Lincoln NE 68510-2564 Ph: (402) 489-0334 | Wedgewood Legacy Medical P.c. 8055 O St Ste S-109 Lincoln NE 68510-2564 Ph: (402) 489-8821 |
NPI Number | 1053347187 |
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Provider Enumeration Date | 06/23/2006 |
Last Update Date | 05/15/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053347187 | NPI | - | NPPES |
10025176100 | Medicaid | NE | |
1902 | Other | NE | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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