MEDICARE: DIALYSIS CENTER OF LINCOLN, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	ESRD020	NE

General Provider Information

NPI Number	:	1679577605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS CENTER OF LINCOLN, INC

Provider Business Mailing Address
First Line	:	7910 O ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-2500
Country	:	US
Telephone Number	:	402-489-5339
Fax Number	:	402-489-7366

Provider Business Practice Location Address
First Line	:	2452 39TH AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2255
Country	:	US
Telephone Number	:	402-563-2139
Fax Number	:	402-563-9145

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. LARRY C EMERSON
Credential	:
Telephone Number	:	402-489-5339

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	05/10/2011

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