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General NPI Number Information
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NPI Number | 1508860529
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Entity Type | Organization
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Legal Business Name | DIALYSIS CENTER OF LINCOLN INC
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 4911 N 26TH ST SUITE 106
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City | LINCOLN
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State | NE
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Zip | 68521-1151
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Country | US
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Telephone | 402-438-7330
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Fax | 402-438-3351
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Provider Business Mailing Address
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Address Line | 7910 O ST
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City | LINCOLN
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State | NE
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Zip | 68510-2500
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Country | US
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Telephone | 402-489-5339
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Fax | 402-489-7366
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Authorized Official
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Title or Position | ADMINISTRATOR / CEO
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Name | MR. LARRY C EMERSON
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Credential |
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Telephone | 402-489-5339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | ESRD022
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License Number State | NE
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