Provider Demographics
NPI:1548331291
Name:LINCOLN SURGICAL GROUP PC
Entity type:Organization
Organization Name:LINCOLN SURGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-483-7825
Mailing Address - Street 1:4740 A ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4822
Mailing Address - Country:US
Mailing Address - Phone:402-483-7825
Mailing Address - Fax:402-483-7839
Practice Address - Street 1:4740 A ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4822
Practice Address - Country:US
Practice Address - Phone:402-483-7825
Practice Address - Fax:402-483-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid