| Organization Name: | CHENEY RIDGE FAMILY MEDICAL CLINIC, PC |
| NPI Number: | 1003044660 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICK BERTOLINI (PRESIDENT) |
| Mailing Address: | 3540 Village Dr Suite 100 Lincoln |
| State: | NE US |
| Postal Code: | 685164706 |
| Phone Number: | 4024207113 |
| Fax Number: | |
| NPI Enumeration Date: | 06/22/2009 |
| NPI Last Update Date: | 04/29/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 16656 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |