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:
Map and Directions
Authorized official contact:
Name: Glenn, Matthew M Doctor of Medicine (MD)
Phone: (402) 423-4200

Health care specialties

SpecialtyCodeLicense #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 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417908666 NPPES
Nebraska Other 02800 BCBS
Nebraska MEDICAID 10025371800 BCBS

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