Healthcare Provider Details

I. General information

NPI: 1144431677
Provider Name (Legal Business Name): SOUTHPOINTE FAMILY PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 S 32ND ST
LINCOLN NE
68516-6025
US

IV. Provider business mailing address

6820 S 32ND ST
LINCOLN NE
68516-6025
US

V. Phone/Fax

Practice location:
  • Phone: 402-323-8400
  • Fax: 402-323-8403
Mailing address:
  • Phone: 402-323-8400
  • Fax: 402-323-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARTIN P MARTIN
Title or Position: OWNER
Credential: M.D.
Phone: 402-323-8400