Pine Lake Health Llc
LBN: Pine Lake Health Llc
Pine Lake Health Llc is an health care organization with primary practice located at 2611 S 70Th St , Lincoln NE 68506-2960. The organization recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Suppliers / Durable Medical Equipment & Medical Supplies, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty.
Pine Lake Health Llc can be contacted via phone (402) 423-4200, or through Glenn, Matthew M via phone (402) 423-4200.
Contact Information
Primary practice address
2611 S 70Th St
Lincoln NE 68506-2960
Phone: (402) 423-4200
Fax: (402) 423-4201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ||
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | ||
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | ||
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X |
Profile Details
| NPI number | 1417908666 |
|---|---|
| LBN Legal business name | Pine Lake Health Llc |
| DBA Doing business as | |
| Authorized official | Glenn, Matthew M Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 12th, 2006 |
| Last updated | Aug 30th, 2022 - about 2 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417908666 | NPPES |
| Nebraska | Other | 02800 | BCBS |
| Nebraska | MEDICAID | 10025371800 | BCBS |
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