Healthcare Provider Details

I. General information

NPI: 1194904201
Provider Name (Legal Business Name): PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 A STREET SUITE 110
LINCOLN NE
68510-4299
US

IV. Provider business mailing address

7001 A STREET SUITE 110
LINCOLN NE
68510-4299
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-0800
  • Fax: 402-489-6803
Mailing address:
  • Phone: 402-489-0800
  • Fax: 402-489-6803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNE

VIII. Authorized Official

Name: TRACY EATON FISHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 402-489-0800