Healthcare Provider Details

I. General information

NPI: 1427158690
Provider Name (Legal Business Name): LONE TREE MEDICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BROADWAY ST
FULLERTON NE
68638-3151
US

IV. Provider business mailing address

2510 18TH AVE
CENTRAL CITY NE
68826-2123
US

V. Phone/Fax

Practice location:
  • Phone: 308-536-2458
  • Fax: 308-536-2459
Mailing address:
  • Phone: 308-946-3845
  • Fax: 308-946-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN SCOT MAHNKE
Title or Position: CORPORATE OFFICER
Credential: M.D.
Phone: 308-946-3845