Organization
LONE TREE MEDICAL ASSOCIATES, P.C.
Active
Parent organization
LONE TREE MEDICAL ASSOCIATES, P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LONE TREE MEDICAL ASSOCIATES, P.C.
Authorized official
STEVEN SCOT MAHNKE M.D. (CORPORATE OFFICER)
(308) 946-3845
Entity
Organization
Contact information
Practice address
901 BROADWAY ST, FULLERTON, NE 68638-3151
(308) 536-2458
(308) 536-2459
Mailing address
2510 18TH AVE, CENTRAL CITY, NE 68826-2123
(308) 946-3845
(308) 946-2357
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
NE
291U00000X
Clinical Medical Laboratory
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025126000
—
NE
01
—
28D0886128
CMS CLIA IDENTIFICATION #
NE
01
—
CD8193
RAILROAD MEDICARE
—
Enumeration date
09/25/2006
Last updated
11/26/2012
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