Provider Demographics
NPI:1255400206
Name:SUPERIOR STREET FAMILY PHYSICIANS
Entity type:Organization
Organization Name:SUPERIOR STREET FAMILY PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAATHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-441-3575
Mailing Address - Street 1:755 FALLBROOK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-9056
Mailing Address - Country:US
Mailing Address - Phone:402-441-3575
Mailing Address - Fax:402-438-2107
Practice Address - Street 1:755 FALLBROOK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-9056
Practice Address - Country:US
Practice Address - Phone:402-441-3575
Practice Address - Fax:402-438-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19203207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========13Medicaid
NE098887Medicare ID - Type UnspecifiedNE MEDICARE #
NE1287840001Medicare NSC
NE=========13Medicaid