Healthcare Provider Details

I. General information

NPI: 1306045968
Provider Name (Legal Business Name): METROPOLITAN PLASTIC & RECONSTRUCTIVE SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17030 LAKESIDE HILLS PLZ SUITE 214
OMAHA NE
68130-2396
US

IV. Provider business mailing address

17030 LAKESIDE HILLS PLZ SUITE 214
OMAHA NE
68130-2396
US

V. Phone/Fax

Practice location:
  • Phone: 402-758-5500
  • Fax: 402-758-5510
Mailing address:
  • Phone: 402-758-5500
  • Fax: 402-758-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. R. COLEEN STICE
Title or Position: PRESIDENT
Credential: MD
Phone: 402-758-5500