Healthcare Provider Details

I. General information

NPI: 1457421471
Provider Name (Legal Business Name): SURGERY GROUP OF GRAND ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N ALPHA ST
GRAND ISLAND NE
68803-4320
US

IV. Provider business mailing address

PO BOX 5226
GRAND ISLAND NE
68802-5226
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-7200
  • Fax: 308-384-7378
Mailing address:
  • Phone: 308-384-7200
  • Fax: 308-384-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANN H MCMICKELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 308-398-8266