Healthcare Provider Details

I. General information

NPI: 1669138905
Provider Name (Legal Business Name): STAR CITY COSMETIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 S 70TH ST STE 202
LINCOLN NE
68506-1500
US

IV. Provider business mailing address

1630 S 70TH ST STE 202
LINCOLN NE
68506-1500
US

V. Phone/Fax

Practice location:
  • Phone: 531-254-5458
  • Fax: 531-254-5065
Mailing address:
  • Phone: 531-254-5458
  • Fax: 531-254-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA PAIGE JACOBSON
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 402-890-6249