MEDICARE: KISMET LXN, LLC.

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	314000000X	Skilled Nursing Facility	224003	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972504207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KISMET LXN, LLC.

Provider Business Mailing Address
First Line	:	1505 N ADAMS ST
Second Line	:
City	:	LEXINGTON
State	:	NE
Zip	:	68850-1243
Country	:	US
Telephone Number	:	308-324-5531
Fax Number	:	308-324-5703

Provider Business Practice Location Address
First Line	:	1505 N ADAMS ST
Second Line	:
City	:	LEXINGTON
State	:	NE
Zip	:	68850-1243
Country	:	US
Telephone Number	:	308-324-5531
Fax Number	:	308-324-5630

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MICHAEL L. MOORE
Credential	:
Telephone Number	:	605-642-7736

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/25/2019

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