1699730663 NPI number — MIDWEST SURGICAL SPECIALISTS, PC

Table of content: SARA HARKNESS BOVITZ MD (NPI 1346356425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699730663 NPI number — MIDWEST SURGICAL SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST SURGICAL SPECIALISTS, PC
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:
1699730663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10020 NICHOLAS ST
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68114-2189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-934-9840
Provider Business Mailing Address Fax Number:
402-934-9846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10020 NICHOLAS ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-2189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-934-9840
Provider Business Practice Location Address Fax Number:
402-934-9846
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARTMAN
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING ADMIN
Authorized Official Telephone Number:
402-934-9840

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  19739 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 19980 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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