Healthcare Provider Details

I. General information

NPI: 1770890386
Provider Name (Legal Business Name): CAROLYN S. CODY, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 16TH ST 200
LINCOLN NE
68502-3796
US

IV. Provider business mailing address

2222 S 16TH ST SUITE 200
LINCOLN NE
68502-3796
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-9090
  • Fax: 402-475-9092
Mailing address:
  • Phone: 402-475-9090
  • Fax: 402-475-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number21626
License Number StateNE

VIII. Authorized Official

Name: CAROLYN S CODY
Title or Position: MEMBER
Credential: M.D.
Phone: 402-475-9090