Provider Demographics
NPI:1508389610
Name:LINCOLN PEDIATRIC GROUP LLC
Entity Type:Organization
Organization Name:LINCOLN PEDIATRIC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-489-3834
Mailing Address - Street 1:5625 S 62ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3558
Mailing Address - Country:US
Mailing Address - Phone:402-489-3834
Mailing Address - Fax:402-489-5049
Practice Address - Street 1:5625 S 62ND ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3558
Practice Address - Country:US
Practice Address - Phone:402-489-3834
Practice Address - Fax:402-489-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1083640130Medicaid