Healthcare Provider Details

I. General information

NPI: 1003266560
Provider Name (Legal Business Name): LINCOLN HOSPITALIST ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S. 48TH STREET SUITE 708
LINCOLN NE
68506-3418
US

IV. Provider business mailing address

1500 S. 48TH STREET SUITE 708
LINCOLN NE
68506-3418
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-8617
  • Fax: 402-483-8698
Mailing address:
  • Phone: 402-483-8617
  • Fax: 402-483-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: ABBIE L FOUGERON
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-483-8613