Healthcare Provider Details

I. General information

NPI: 1720058688
Provider Name (Legal Business Name): SURGICENTER OF NORFOLK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 W NORFOLK AVE STE L
NORFOLK NE
68701-9218
US

IV. Provider business mailing address

6128 S LYNCREST AVE
SIOUX FALLS SD
57108-2560
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-5555
  • Fax:
Mailing address:
  • Phone: 844-698-9578
  • Fax: 605-274-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASC023
License Number StateNE

VIII. Authorized Official

Name: DANIELLE MARIE JOHNSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-379-5555