Provider Demographics
NPI:1083640437
Name:LISA I MANSUR MD PC
Entity Type:Organization
Organization Name:LISA I MANSUR MD PC
Other - Org Name:PALLIATIVE CARE SERVICES OF NEBRASKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MANSUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-328-8863
Mailing Address - Street 1:3401 PLANTATION DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4712
Mailing Address - Country:US
Mailing Address - Phone:402-328-8863
Mailing Address - Fax:402-328-8078
Practice Address - Street 1:3401 PLANTATION DR
Practice Address - Street 2:SUITE 160
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4712
Practice Address - Country:US
Practice Address - Phone:402-328-8863
Practice Address - Fax:402-328-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20419207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
099431Medicare PIN