Provider Demographics
NPI:1982235883
Name:DERMATOLOGY ASSOCIATES OF LINCOLN, LLC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF LINCOLN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:Z
Authorized Official - Last Name:FRICKE
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:402-413-7460
Mailing Address - Street 1:6969 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2835
Mailing Address - Country:US
Mailing Address - Phone:402-413-7460
Mailing Address - Fax:402-413-7486
Practice Address - Street 1:6969 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2835
Practice Address - Country:US
Practice Address - Phone:402-413-7460
Practice Address - Fax:402-413-7486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026824600Medicaid
NEEA0767OtherRAILROAD MEDICARE PTAN