Healthcare Provider Details

I. General information

NPI: 1801831268
Provider Name (Legal Business Name): SURGICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S 70TH ST STE 100
LINCOLN NE
68510-7901
US

IV. Provider business mailing address

1001 S 70TH ST STE 100
LINCOLN NE
68510-7901
US

V. Phone/Fax

Practice location:
  • Phone: 402-441-4760
  • Fax: 402-441-4764
Mailing address:
  • Phone: 402-441-4760
  • Fax: 402-441-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JOEL MASON GUSTAFSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-441-4760