Provider Demographics
NPI:1144431677
Name:SOUTHPOINTE FAMILY PHYSICIANS, P.C.
Entity type:Organization
Organization Name:SOUTHPOINTE FAMILY PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-323-8400
Mailing Address - Street 1:6820 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6025
Mailing Address - Country:US
Mailing Address - Phone:402-323-8400
Mailing Address - Fax:402-323-8403
Practice Address - Street 1:6820 S 32ND ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6025
Practice Address - Country:US
Practice Address - Phone:402-323-8400
Practice Address - Fax:402-323-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01837OtherBCBS
CH4102OtherMEDICARE TRAVELERS
CH4102OtherMEDICARE TRAVELERS
=========OtherTRICARE
NE01837OtherBCBS