Healthcare Provider Details

I. General information

NPI: 1013936012
Provider Name (Legal Business Name): PLASTIC SURGICAL ARTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 LUCILE DR STE 103
LINCOLN NE
68516-4211
US

IV. Provider business mailing address

4400 LUCILE DR STE 103
LINCOLN NE
68516-4211
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-2572
  • Fax: 402-483-2619
Mailing address:
  • Phone: 402-483-2572
  • Fax: 402-483-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TINA OLIVARES
Title or Position: MANAGER
Credential:
Phone: 402-483-2572