Healthcare Provider Details

I. General information

NPI: 1508171612
Provider Name (Legal Business Name): PRIMUS HEALTH CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PINE LAKE RD
LINCOLN NE
68516-5489
US

IV. Provider business mailing address

3900 PINE LAKE RD
LINCOLN NE
68516-5489
US

V. Phone/Fax

Practice location:
  • Phone: 402-421-2100
  • Fax: 402-421-2104
Mailing address:
  • Phone: 402-421-2100
  • Fax: 402-421-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW M GLENN
Title or Position: OWNER
Credential: MD
Phone: 402-421-2100