Healthcare Provider Details

I. General information

NPI: 1821513722
Provider Name (Legal Business Name): GOOD FAITH FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8055 O STREET SUITE 100
LINCOLN NE
68510
US

IV. Provider business mailing address

8055 O ST STE 100
LINCOLN NE
68510-2575
US

V. Phone/Fax

Practice location:
  • Phone: 402-488-4022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CANDICE HOTTOVY
Title or Position: MANAGER
Credential:
Phone: 402-488-4022