Healthcare Provider Details

I. General information

NPI: 1356532782
Provider Name (Legal Business Name): DIALYSIS CENTER OF LINCOLN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 S 16TH ST
LINCOLN NE
68512-1277
US

IV. Provider business mailing address

7910 O STREET
LINCOLN NE
68510-2500
US

V. Phone/Fax

Practice location:
  • Phone: 402-742-8500
  • Fax: 402-328-9210
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 Number
License Number StateNE

VIII. Authorized Official

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