# LONE TREE MEDICAL ASSOCIATES, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LONE TREE MEDICAL ASSOCIATES, P.C.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1427158690
- **Legal business name:** LONE TREE MEDICAL ASSOCIATES, P.C.
- **Authorized official:** STEVEN SCOT MAHNKE M.D. (CORPORATE OFFICER)
- **Authorized official phone:** (308) 946-3845

## Contact information

- **Practice address:** 901 BROADWAY ST, FULLERTON, NE 68638-3151
- **Practice address phone:** (308) 536-2458
- **Practice address fax:** (308) 536-2459
- **Mailing address:** 2510 18TH AVE, CENTRAL CITY, NE 68826-2123
- **Mailing address phone:** (308) 946-3845
- **Mailing address fax:** (308) 946-2357

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QR1300X | Rural Health Clinic/Center | — | NE | — |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 09/25/2006
- **Last updated:** 11/26/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10025126000 | — | NE |
| 01 | — | 28D0886128 | CMS CLIA IDENTIFICATION \# | NE |
| 01 | — | CD8193 | RAILROAD MEDICARE | — |