James Dedrickson
Individual provider Active NPI Contractor · Lincoln, NE
NPI 1124836150 · NPPES record last updated Dec 23, 2024
Key facts
- NPI
- 1124836150
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 1431 Makers St
Lincoln, NE 68521-3401 - Phone
- (402) 320-2174
- NPI assigned
- Dec 23, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Goliath Advocacy LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor |
171W00000X | Yes |
Addresses
Primary practice location
1431 Makers St
Lincoln, NE 68521-3401
Mailing address
304 Riverview St
Leshara, NE 68064-1514
Phone (402) 320-2174
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41618345 | Medicaid | NE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Desktop | Direct |
Other providers in Lincoln, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.