Provider Demographics
NPI:1629260336
Name:NORTH LINCOLN FAMILY MEDICAL CENTER PC
Entity Type:Organization
Organization Name:NORTH LINCOLN FAMILY MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRESHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-477-6600
Mailing Address - Street 1:3100 N 14TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-2134
Mailing Address - Country:US
Mailing Address - Phone:402-477-6600
Mailing Address - Fax:402-477-7369
Practice Address - Street 1:3100 N 14TH ST
Practice Address - Street 2:STE 201
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-2134
Practice Address - Country:US
Practice Address - Phone:402-477-6600
Practice Address - Fax:402-477-7369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE1255830001Medicare NSC
NE092651Medicare PIN