Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Pine Lake Health LLC

Organization Family Medicine Physician · NPI 1417908666

Pine Lake Health LLC is a Family Medicine Physician in Lincoln, Nebraska. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
4
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2611 S 70th St
Lincoln, NE 68506-2960
Phone: (402) 423-4200
Fax: (402) 423-4201
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Durable Medical Equipment & Medical Supplies Taxonomy 332B00000X
Physician Assistant Taxonomy 363A00000X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1417908666
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Matthew Glenn — President · (402) 423-4200
NPI enumeratedMay 12, 2006
Last updated in NPPESAugust 30, 2022
Certification dateAugust 30, 2022
Mailing address2611 S 70th St, Lincoln, NE 68506-2960

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