Provider Demographics
NPI:1508829300
Name:EDGEWOOD FAMILY PHYSICIANS PC
Entity Type:Organization
Organization Name:EDGEWOOD FAMILY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-421-6200
Mailing Address - Street 1:5200 S 56TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1891
Mailing Address - Country:US
Mailing Address - Phone:402-421-6200
Mailing Address - Fax:402-421-6070
Practice Address - Street 1:5200 S 56TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1884
Practice Address - Country:US
Practice Address - Phone:402-421-6200
Practice Address - Fax:402-421-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEC50349OtherRAILROAD MEDICARE
NE=========13Medicaid
NE=========13Medicaid
NE0817760001Medicare NSC