Provider Demographics
NPI:1124548540
Name:SOUTH LINCOLN FAMILY PHYSICIANS, PC
Entity Type:Organization
Organization Name:SOUTH LINCOLN FAMILY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DENELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:402-483-2987
Mailing Address - Street 1:3201 PIONEERS BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5963
Mailing Address - Country:US
Mailing Address - Phone:402-483-2987
Mailing Address - Fax:
Practice Address - Street 1:3201 PIONEERS BLVD STE 304
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5963
Practice Address - Country:US
Practice Address - Phone:402-483-2987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144337643OtherQUALITY INCENTIVE