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General NPI Number Information
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NPI Number | 1235273590
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Entity Type | Organization
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Legal Business Name | LINCOLN FAMILY MEDICAL GROUP PC
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 705 N 17TH AVE
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City | ASHLAND
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State | NE
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Zip | 68003-1209
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Country | US
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Telephone | 402-944-2201
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Fax |
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Provider Business Mailing Address
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Address Line | 705 N 17TH AVE
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City | ASHLAND
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State | NE
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Zip | 68003-1209
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Country | US
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Telephone | 402-944-2201
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | DAVID KLITZKE
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Credential |
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Telephone | 402-488-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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