Healthcare Provider Details

I. General information

NPI: 1215333174
Provider Name (Legal Business Name): DIALYSIS CENTER OF LINCOLN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
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 Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number732
License Number StateNE

VIII. Authorized Official

Name: MS. TAMMY JORENE BURTON-FIKAR
Title or Position: RENAL DIETITIAN
Credential: RD CSG LMNT
Phone: 402-489-5339