Provider Demographics
NPI:1790713105
Name:CENTRAL NEBRASKA NEUROLOGY PC
Entity Type:Organization
Organization Name:CENTRAL NEBRASKA NEUROLOGY PC
Other - Org Name:CENTRAL NEBRASKA NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-463-1250
Mailing Address - Street 1:2727 WEST 2ND ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901
Mailing Address - Country:US
Mailing Address - Phone:402-463-1250
Mailing Address - Fax:402-463-1461
Practice Address - Street 1:2727 WEST 2ND ST
Practice Address - Street 2:SUITE 340
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901
Practice Address - Country:US
Practice Address - Phone:402-463-1250
Practice Address - Fax:402-463-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE200772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025015900Medicaid
NE10025015900Medicaid