Healthcare Provider Details

I. General information

NPI: 1174654321
Provider Name (Legal Business Name): SOUTH LINCOLN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S 48TH ST SUITE 708
LINCOLN NE
68506-1225
US

IV. Provider business mailing address

1500 SO. 48TH ST. SUITE 708
LINCOLN NE
68506
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-3444
  • Fax: 402-486-3590
Mailing address:
  • Phone: 402-486-3444
  • Fax: 402-486-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20387
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14394
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18104
License Number StateNE

VIII. Authorized Official

Name: ANTHONY J ROSS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-486-3444