Provider Demographics
NPI:1508171612
Name:PRIMUS HEALTH CARE PC
Entity Type:Organization
Organization Name:PRIMUS HEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-421-2100
Mailing Address - Street 1:3900 PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5489
Mailing Address - Country:US
Mailing Address - Phone:402-421-2100
Mailing Address - Fax:402-421-2104
Practice Address - Street 1:3900 PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5489
Practice Address - Country:US
Practice Address - Phone:402-421-2100
Practice Address - Fax:402-421-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025945600Medicaid
NE10025945800Medicaid
NE10025951700Medicaid
NE10026136000Medicaid
NE10026145200Medicaid
NE10025945200Medicaid
NE10025951900Medicaid
NE10026145100Medicaid
NE10025945300Medicaid
NE10025951600Medicaid
NE10025945500Medicaid
NE10025951800Medicaid
NE10025898200Medicaid
NE10025945700Medicaid
NE10025945400Medicaid
NE10025945600Medicaid
NE10025945800Medicaid