PINE LAKE HEALTH LLC (NPI# 1780814475) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780814475 |
| Entity Type | Organization |
| Organization Name | PINE LAKE HEALTH LLC |
| Other Organization Name | WAVERLY HEALTH CARE URGENT CARE |
| Practice Address |
13220 Callum Dr Ste 4 Waverly NE 68462-2561 |
| Mailing Address |
9100 Andermatt Dr Ste 2 Lincoln NE 68526-6700 |
| Practice Telephone | 4027865563 |
| Practice Fax Number | 4024234201 |
| Mailing Telephone | 4024234218 |
| Mailing Fax Number | 4024234201 |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2019-09-12 |
| Authorized Official Name | DR. MATTHEW M GLENN (PHYSICIAN) |
| Authorized Official Telephone | 4024234200 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | PINE LAKE HEALTH, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | 10025748100 | 05 |
| Other Name | Type Code |
|---|---|
| Waverly Health Care Urgent Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558699850 | Pine Lake Health LLC | Nurse Practitioner | 211 S 23rd St, Plattsmouth, NE 68048-2903 | 2009-11-24 |
| 1417908666 | Pine Lake Health LLC | Durable Medical Equipment & Medical Supplies | 9100 Andermatt Dr Ste 2, Lincoln, NE 68526-6700 | 2006-05-12 |
| Street Address |
13220 CALLUM DR STE 4 |
| City | WAVERLY |
| State | NE |
| Zip Code | 68462-2561 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932146057 | Christine A Rollman | Chiropractor | 13220 Callum Dr, Ste 2, Waverly, NE 68462-2561 | 2006-05-31 |
| 1164966412 | Xceed Chiropractic, PC | Chiropractor | 13220 Callum Dr, Ste 2, Waverly, NE 68462-2561 | 2016-12-06 |
| 1124348271 | Rider Chiropractic PC | Chiropractor | 13220 Callum Dr, Suite 2, Waverly, NE 68462-2561 | 2010-06-10 |
| 1366760100 | Rachelle Lee Rider | Chiropractor | 13220 Callum Dr, Suite 2, Waverly, NE 68462-2561 | 2010-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942683750 | Rocker Chiropractic PC | Chiropractor | 13220 Callum Drive Ste. 2, Waverly, NE 68462 | 2015-06-30 |
| 1134404189 | Heather M Eller-gilman | Counselor | 10630 N 136th St, Waverly, NE 68462 | 2011-10-20 |
| 1477699445 | City of Waverly | Ambulance | 10530 N. 141st, Waverly, NE 68462 | 2007-01-29 |
| 1487727293 | Four Star Drug of Waverly | Pharmacy | 13851 Guildford St, Suite D, Waverly, NE 68462 | 2006-11-17 |
| 1871549592 | Five Star Quality Care-ne LLC | Skilled Nursing Facility | 11041 N 137th St, Waverly, NE 68462-1022 | 2006-05-25 |
| 1326695735 | Dell Marie Hobler | Occupational Therapy Assistant | 11041 N 137th St, Waverly, NE 68462-1022 | 2019-08-20 |
| 1669033072 | Bcp Waverly, LLC | Skilled Nursing Facility | 11041 N 137th St, Waverly, NE 68462-1022 | 2019-06-26 |
| 1750888731 | Shelby Ann Hutchings | Occupational Therapist | 11041 N 137th St, Waverly, NE 68462-1022 | 2018-04-06 |
| 1073937975 | Tina Rogers | Skilled Nursing Facility | 11041 N 137th St, Waverly, NE 68462-1022 | 2014-02-12 |
| 1225462526 | Barry Lee Schwab | Physical Therapist | 11041 N 137th St, Waverly, NE 68462-1022 | 2013-08-23 |
| Find all providers in zip 68462 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568953651 | Tiffany Renee Bagwell | Family Medicine | 401 Gregson Pl, Waverly, TN 37185-2925 | 2018-05-23 |
| 1326574062 | Nicole Rex | Family Medicine | 135 Cedar Hill Dr, Waverly, OH 45690-9142 | 2017-05-01 |
| 1518301522 | Kimberly Ann Kabernagel | Family Medicine | 12 Lily Lake Rd, Waverly, PA 18471-0036 | 2013-04-21 |
| 1225224405 | Sumita Aggarwal | Family Medicine | 227 Valley View Dr., Waverly, OH 45690 | 2007-09-20 |
| 1225248701 | Bristol Village Homes | Family Medicine | 621 E 5th St, Waverly, OH 45690-1505 | 2007-05-23 |
| 1386794816 | Lawrence Richard Jackson Jr. | Family Medicine | 102 Hillwood Dr, Waverly, TN 37185 | 2007-01-10 |
| 1548379381 | Terry A Johnson | Family Medicine | 715 W Emmitt Ave, Waverly, OH 45690-1015 | 2006-08-29 |
| 1437176286 | Harry T Kittaka | Family Medicine | 12340 State Route 104, Waverly, OH 45690-8968 | 2006-07-17 |
| 1053390906 | George Coleman | Family Medicine | 344 W Main St, Waverly, VA 23890-3235 | 2006-01-10 |
| 1467430181 | Timothy C Horrigan | Family Medicine | 217 20th St Nw, Waverly, IA 50677 | 2006-01-03 |
| Find all providers in WAVERLY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.