Healthcare Provider Details

I. General information

NPI: 1235273590
Provider Name (Legal Business Name): LINCOLN FAMILY MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N 17TH AVE
ASHLAND NE
68003-1209
US

IV. Provider business mailing address

705 N 17TH AVE
ASHLAND NE
68003-1209
US

V. Phone/Fax

Practice location:
  • Phone: 402-944-2201
  • Fax:
Mailing address:
  • Phone: 402-944-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID KLITZKE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 402-488-7400