Healthcare Provider Details

I. General information

NPI: 1548710775
Provider Name (Legal Business Name): LINCOLN DIGESTIVE HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S 16TH ST SUITE 512
LINCOLN NE
68502-3704
US

IV. Provider business mailing address

4545 R ST 100
LINCOLN NE
68503-3799
US

V. Phone/Fax

Practice location:
  • Phone: 402-465-4545
  • Fax: 402-465-9011
Mailing address:
  • Phone: 402-465-3633
  • Fax: 402-465-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATE KREIFELS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 402-465-4545