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

Pine Lake Health LLC

Organization Family Medicine Physician · NPI 1780814475

Pine Lake Health LLC is a Family Medicine Physician in Waverly, Nebraska. Registered with an NPI since 2009.

In the registry since
2009
Specialties on file
3
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

13220 Callum Dr Ste 4
Waverly, NE 68462-2561
Phone: (402) 786-5563
Fax: (402) 423-4201
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Physician Assistant Taxonomy 363A00000X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1780814475
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationPine Lake Health, LLC
Authorized official Matthew Glenn — Physician · (402) 423-4200
Other names Waverly Health Care Urgent Care; Waverly Health Care Urgent Care
NPI enumeratedJuly 16, 2009
Last updated in NPPESAugust 30, 2022
Certification dateAugust 30, 2022
Mailing address2611 S 70th St, Lincoln, NE 68506-2960

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