Provider Demographics
NPI:1992741300
Name:LINCOLN ENDOSCOPY CENTER, LLC
Entity type:Organization
Organization Name:LINCOLN ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-465-4545
Mailing Address - Street 1:4545 R ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3799
Mailing Address - Country:US
Mailing Address - Phone:402-465-4545
Mailing Address - Fax:402-465-3621
Practice Address - Street 1:4545 R ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3799
Practice Address - Country:US
Practice Address - Phone:402-465-4545
Practice Address - Fax:402-465-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEASC011261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-00Medicaid