Provider Demographics
NPI:1639479363
Name:LINCOLN PHYSICIAN NETWORK LLC
Entity Type:Organization
Organization Name:LINCOLN PHYSICIAN NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REX
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:RECKEWEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-421-0896
Mailing Address - Street 1:2000 Q ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3609
Mailing Address - Country:US
Mailing Address - Phone:402-421-0904
Mailing Address - Fax:
Practice Address - Street 1:3910 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4783
Practice Address - Country:US
Practice Address - Phone:402-434-7383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PHYSICIAN NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-28
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies