# PINE LAKE INTENSITY-MODULATED

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pine Lake IMRT
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174674691
- **Authorized official:** BENNETT BARRIOS MD (MANAGING MEMBER)
- **Authorized official phone:** (402) 327-7300

## Contact information

- **Practice address:** 3901 PINE LAKE RD, SUITE 111, LINCOLN, NE 68516-5497
- **Practice address phone:** (402) 481-6090
- **Mailing address:** 3901 PINE LAKE RD, SUITE 111, LINCOLN, NE 68516-5497
- **Mailing address phone:** (402) 481-6090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0203X | Radiation Oncology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/12/2007
- **Last updated:** 12/11/2009