1255346045 NPI number — OMEGA SURGERY CENTER LLC

Table of content: (NPI 1255346045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255346045 NPI number — OMEGA SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMEGA SURGERY CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255346045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11606 NICHOLAS ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68154-4478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-493-2020
Provider Business Mailing Address Fax Number:
402-493-8341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11606 NICHOLAS ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68154-4478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-493-2020
Provider Business Practice Location Address Fax Number:
402-493-8341
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIU
Authorized Official First Name:
SAO
Authorized Official Middle Name:
JANG
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
402-493-2020

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31910 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 6890031 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0548354 . This is a "IOWA MEDICAID" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 490004242 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: F231768 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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