Provider Demographics
NPI:1346940210
Name:MEDELITE URGENT CARE L.L.C.
Entity Type:Organization
Organization Name:MEDELITE URGENT CARE L.L.C.
Other - Org Name:ME WELLNESS CARE & AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-340-2505
Mailing Address - Street 1:15877 S 64TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCA
Mailing Address - State:NE
Mailing Address - Zip Code:68430-4355
Mailing Address - Country:US
Mailing Address - Phone:402-340-2505
Mailing Address - Fax:
Practice Address - Street 1:7120 S. 69TH STREET
Practice Address - Street 2:SUITE 101A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516
Practice Address - Country:US
Practice Address - Phone:402-340-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty