Provider Demographics
NPI:1194904201
Name:PEDIATRICS, P.C.
Entity type:Organization
Organization Name:PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:EATON
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-489-0800
Mailing Address - Street 1:7001 A STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4299
Mailing Address - Country:US
Mailing Address - Phone:402-489-0800
Mailing Address - Fax:402-489-6803
Practice Address - Street 1:7001 A STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4299
Practice Address - Country:US
Practice Address - Phone:402-489-0800
Practice Address - Fax:402-489-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========12Medicaid