Provider Demographics
NPI:1295879559
Name:LINCOLN FAMILY MEDICAL GROUP PC
Entity type:Organization
Organization Name:LINCOLN FAMILY MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KLITZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-488-7400
Mailing Address - Street 1:7441 O ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2466
Mailing Address - Country:US
Mailing Address - Phone:402-488-7400
Mailing Address - Fax:
Practice Address - Street 1:7441 O ST STE 400
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2466
Practice Address - Country:US
Practice Address - Phone:402-488-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01996OtherBCBS
NE=========13Medicaid
NE=========13Medicaid