Healthcare Provider Details

I. General information

NPI: 1467490433
Provider Name (Legal Business Name): UROLOGY SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 PINE LAKE RD
LINCOLN NE
68516-3389
US

IV. Provider business mailing address

5500 PINE LAKE RD
LINCOLN NE
68516-3389
US

V. Phone/Fax

Practice location:
  • Phone: 402-421-8899
  • Fax: 402-421-8950
Mailing address:
  • Phone: 402-421-8899
  • Fax: 402-421-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASC028
License Number StateNE

VIII. Authorized Official

Name: JENNA STRATMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-489-8888