Organization
LAKESIDE ORTHOPEDICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY J. MICKELSON (OFFICE MANAGER)
(402) 758-5690
Entity
Organization
Contact information
Practice address
1413 SOUTH WASHINTON, SUITE 200, PAPILLION, NE 68046
(402) 758-5690
(402) 758-5699
Mailing address
16909 LAKESIDE HILLS CT, SUITE 208, OMAHA, NE 68130-4664
(402) 758-5690
(402) 758-5699
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025497200
—
NE
Enumeration date
08/10/2007
Last updated
11/15/2007
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