Healthcare Provider Details

I. General information

NPI: 1326107509
Provider Name (Legal Business Name): OMAHA AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N 90TH ST
OMAHA NE
68114-2702
US

IV. Provider business mailing address

825 N 90TH ST
OMAHA NE
68114-2706
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-7246
  • Fax: 402-408-1783
Mailing address:
  • Phone: 402-391-7246
  • Fax: 402-408-1783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIONNE MARIA FINKEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-391-7246