Provider Demographics
NPI:1871653568
Name:LINCOLN RADIOLOGY LLC
Entity Type:Organization
Organization Name:LINCOLN RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WINJUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-420-3500
Mailing Address - Street 1:PO BOX 7328
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-0328
Mailing Address - Country:US
Mailing Address - Phone:402-489-9400
Mailing Address - Fax:
Practice Address - Street 1:7121 STEPHANIE LN
Practice Address - Street 2:STE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5359
Practice Address - Country:US
Practice Address - Phone:402-420-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025493200Medicaid
IA1871653568Medicaid
NE10025493200Medicaid
IA1871653568Medicaid