Basic Information
| Provider Information | |||||||||
| NPI: | 1205861788 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OMAHA CENTER FOR SURGERY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4242 FARNAM ST | ||||||||
| Address2: | #370 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681312806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025523078 | ||||||||
| FaxNumber: | 4025523075 | ||||||||
| Practice Location | |||||||||
| Address1: | 4242 FARNAM ST | ||||||||
| Address2: | #370 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681312806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025523078 | ||||||||
| FaxNumber: | 4025523075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | D.O./PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4025523078 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 10024993900 | 05 | NE | MEDICAID |