Provider Demographics
NPI:1306840335
Name:DIALYSIS CENTER OF LINCOLN, INC.
Entity Type:Organization
Organization Name:DIALYSIS CENTER OF LINCOLN, INC.
Other - Org Name:DIALYSIS CENTER OF LINCOLN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-489-5339
Mailing Address - Street 1:7910 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2500
Mailing Address - Country:US
Mailing Address - Phone:402-489-5339
Mailing Address - Fax:402-489-7366
Practice Address - Street 1:7910 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2500
Practice Address - Country:US
Practice Address - Phone:402-489-5339
Practice Address - Fax:402-489-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEESRD021261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00260OtherBCBSNE
87726OtherUNITED HEALTHCARE
NE25136OtherCOVENTRY HEALTHCARE OF NEBRASKA
NE=========00Medicaid
NE25136OtherCOVENTRY HEALTHCARE OF NEBRASKA
87726OtherUNITED HEALTHCARE