Provider Demographics
NPI:1235273590
Name:LINCOLN FAMILY MEDICAL GROUP PC
Entity Type:Organization
Organization Name:LINCOLN FAMILY MEDICAL GROUP PC
Other - Org Name:LFMG ASHLAND CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KLITZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-488-7400
Mailing Address - Street 1:705 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003-1209
Mailing Address - Country:US
Mailing Address - Phone:402-944-2201
Mailing Address - Fax:
Practice Address - Street 1:705 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NE
Practice Address - Zip Code:68003-1209
Practice Address - Country:US
Practice Address - Phone:402-944-2201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINCOLN FAMILY MEDICAL GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-19
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE096105Medicare ID - Type Unspecified
NE01996OtherBCBS
NE=========14Medicaid