Provider Demographics
NPI:1144337643
Name:SOUTH LINCOLN FAMILY PHYSICIANS, PC
Entity type:Organization
Organization Name:SOUTH LINCOLN FAMILY PHYSICIANS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-483-2987
Mailing Address - Street 1:4424 S 86TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9225
Mailing Address - Country:US
Mailing Address - Phone:402-483-2987
Mailing Address - Fax:402-483-2980
Practice Address - Street 1:4424 S 86TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9225
Practice Address - Country:US
Practice Address - Phone:402-483-2987
Practice Address - Fax:402-483-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE02866OtherBCBS
NE1144337643OtherRR MEDICARE
NE02866OtherBCBS
NE=========13Medicaid
0931200001Medicare NSC