Provider Demographics
NPI:1427251941
Name:PIERCE FAMILY PRACTICE L.L.C.
Entity type:Organization
Organization Name:PIERCE FAMILY PRACTICE L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-450-8399
Mailing Address - Street 1:4430 ASH HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2983
Mailing Address - Country:US
Mailing Address - Phone:402-450-8399
Mailing Address - Fax:402-858-1281
Practice Address - Street 1:4430 ASH HOLLOW CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2983
Practice Address - Country:US
Practice Address - Phone:402-450-8399
Practice Address - Fax:402-858-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20387207Q00000X
NE18104207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDF8738OtherRAILROAD MEDICARE
NE10025522700Medicaid
NEDF8738OtherRAILROAD MEDICARE