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Organization
PINE LAKE HEALTH LLC
Active
Organization
PINE LAKE HEALTH LLC
Active
Parent organization
PINE LAKE HEALTH, LLC
Other names
Waverly Health Care Urgent Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
PINE LAKE HEALTH, LLC
Authorized official
DR. MATTHEW M GLENN MD (PHYSICIAN)
(402) 423-4200
Entity
Organization
Contact information
Practice address
13220 CALLUM DR, STE 4, WAVERLY, NE 68462-2561
(402) 786-5563
(402) 423-4201
Mailing address
2611 S 70TH ST, LINCOLN, NE 68506-2960
(402) 423-4200
(402) 423-4201
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025748100
—
NE
Enumeration date
07/16/2009
Last updated
08/30/2022
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