Healthcare Provider Details

I. General information

NPI: 1255809620
Provider Name (Legal Business Name): PRAIRIE ORTHOPAEDIC & PLASTIC SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 PIONEER WOODS DR STE 1
LINCOLN NE
68506-7552
US

IV. Provider business mailing address

4130 PIONEER WOODS DR STE 1
LINCOLN NE
68506-7552
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-4700
  • Fax: 402-489-5220
Mailing address:
  • Phone: 402-489-4700
  • Fax: 402-489-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK T HURLBUT
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 402-489-4700