Healthcare Provider Details

I. General information

NPI: 1285559567
Provider Name (Legal Business Name): BE WELL GERIATRICS, MEMORY, AND LONGEVITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 HIDCOTE DR STE 103
LINCOLN NE
68516-5536
US

IV. Provider business mailing address

5800 HIDCOTE DR STE 103
LINCOLN NE
68516-5536
US

V. Phone/Fax

Practice location:
  • Phone: 402-429-7448
  • Fax: 402-429-7448
Mailing address:
  • Phone: 402-429-7448
  • Fax: 402-429-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK D CARLSON
Title or Position: CEO
Credential: MD
Phone: 402-429-7448