Provider Demographics
NPI:1366854358
Name:LITZENBERG MEMORIAL MERRICK COUNTY
Entity Type:Organization
Organization Name:LITZENBERG MEMORIAL MERRICK COUNTY
Other - Org Name:LONE TREE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-946-3015
Mailing Address - Street 1:1715 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-9501
Mailing Address - Country:US
Mailing Address - Phone:308-946-3015
Mailing Address - Fax:308-946-5914
Practice Address - Street 1:901 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:NE
Practice Address - Zip Code:68638-3151
Practice Address - Country:US
Practice Address - Phone:308-536-2458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITZENBERG MEMORIAL MERRICK COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-23
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2502Medicare PIN
NE288530Medicare Oscar/Certification