Provider Demographics
NPI:1518164243
Name:ROSS INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:ROSS INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-362-7677
Mailing Address - Street 1:2611 S 70TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2960
Mailing Address - Country:US
Mailing Address - Phone:402-362-7677
Mailing Address - Fax:
Practice Address - Street 1:2611 S 70TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2960
Practice Address - Country:US
Practice Address - Phone:402-362-7677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty