Healthcare Provider Details

I. General information

NPI: 1285823773
Provider Name (Legal Business Name): STAR CITY SURGICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 S 75TH ST
LINCOLN NE
68506-4607
US

IV. Provider business mailing address

PO BOX 6213
LINCOLN NE
68506-0213
US

V. Phone/Fax

Practice location:
  • Phone: 402-440-8636
  • Fax: 402-486-0243
Mailing address:
  • Phone: 402-440-8636
  • Fax: 402-486-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number20093
License Number StateNE

VIII. Authorized Official

Name: DR. JUDITH KAY DEGRAFF
Title or Position: M.D.
Credential: M.D.
Phone: 402-440-8636