Healthcare Provider Details

I. General information

NPI: 1346940210
Provider Name (Legal Business Name): MEDELITE URGENT CARE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 S. 69TH STREET SUITE 101A
LINCOLN NE
68516
US

IV. Provider business mailing address

15877 S 64TH ST
ROCA NE
68430-4355
US

V. Phone/Fax

Practice location:
  • Phone: 402-499-2883
  • Fax:
Mailing address:
  • Phone: 402-340-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA JOHNSON
Title or Position: OFFICE MANAGER/PROVIDER/CO-OWNER
Credential: PA
Phone: 402-499-2883