Healthcare Provider Details

I. General information

NPI: 1932419009
Provider Name (Legal Business Name): TRAUMA SURGICAL CRITICAL CARE ASSOCIATES OF NEBRASKA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S 16TH ST
LINCOLN NE
68502-3704
US

IV. Provider business mailing address

1550 S 70TH ST STE 202
LINCOLN NE
68506-1576
US

V. Phone/Fax

Practice location:
  • Phone: 402-440-4405
  • Fax:
Mailing address:
  • Phone: 402-328-8833
  • Fax: 402-328-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. VALARIE K JOHNSTON
Title or Position: BILLING DIRECTOR
Credential:
Phone: 402-328-8833