Healthcare Provider Details

I. General information

NPI: 1861497380
Provider Name (Legal Business Name): NORTHEAST NEBRASKA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W NORFOLK AVE STE 101
NORFOLK NE
68701-4408
US

IV. Provider business mailing address

2701 W NORFOLK AVE STE 101
NORFOLK NE
68701-4408
US

V. Phone/Fax

Practice location:
  • Phone: 402-644-7262
  • Fax: 402-644-7227
Mailing address:
  • Phone: 402-644-7262
  • Fax: 402-644-7227

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: KELLY A. DRISCOLL
Title or Position: MEMBER OF BOARD OF MANAGERS
Credential:
Phone: 402-644-7637