Basic Information
| Provider Information | |||||||||
| NPI: | 1457396244 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GYNECOLOGIC SURGEONS & OBSTETRICIANS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6050 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685164732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024218581 | ||||||||
| FaxNumber: | 4024218594 | ||||||||
| Practice Location | |||||||||
| Address1: | 6050 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685164732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024218581 | ||||||||
| FaxNumber: | 4024218594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | TOMJACK | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4024218581 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 28D0455238 | 01 | NE | CLIA | OTHER |