Healthcare Provider Details

I. General information

NPI: 1356364335
Provider Name (Legal Business Name): NEBRASKA UROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 PINE LAKE RD
LINCOLN NE
68516
US

IV. Provider business mailing address

5500 PINE LAKE RD
LINCOLN NE
68516-3389
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-8888
  • Fax: 402-421-1945
Mailing address:
  • Phone: 402-489-8888
  • Fax: 402-421-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: TARA MICHELE KIRKPATRICK
Title or Position: PRESIDENT
Credential:
Phone: 402-489-8888