Healthcare Provider Details

I. General information

NPI: 1306840335
Provider Name (Legal Business Name): DIALYSIS CENTER OF LINCOLN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 O ST
LINCOLN NE
68510-2500
US

IV. Provider business mailing address

7910 O ST
LINCOLN NE
68510-2500
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-5339
  • Fax: 402-489-7366
Mailing address:
  • Phone: 402-489-5339
  • Fax: 402-489-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberESRD021
License Number StateNE

VIII. Authorized Official

Name: MR. LARRY C EMERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-489-5339