Healthcare Provider Details

I. General information

NPI: 1508483785
Provider Name (Legal Business Name): DR. SEBASTIAN LANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MERCY DR STE 220
COUNCIL BLUFFS IA
51503-3128
US

IV. Provider business mailing address

7710 MERCY RD STE 2000
OMAHA NE
68124-2323
US

V. Phone/Fax

Practice location:
  • Phone: 712-388-2660
  • Fax: 712-388-2665
Mailing address:
  • Phone: 402-717-1820
  • Fax: 402-717-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number37409
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-57272
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: