Provider Demographics
NPI:1861915886
Name:CAPITAL CITY PEDIATRICS, LLC
Entity type:Organization
Organization Name:CAPITAL CITY PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-483-6036
Mailing Address - Street 1:7441 O ST STE 303
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2466
Mailing Address - Country:US
Mailing Address - Phone:402-483-6036
Mailing Address - Fax:402-483-6294
Practice Address - Street 1:7441 O ST STE 303
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2466
Practice Address - Country:US
Practice Address - Phone:402-483-6036
Practice Address - Fax:402-483-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty