Healthcare Provider Details

I. General information

NPI: 1295429496
Provider Name (Legal Business Name): CHOICE SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8814 MAPLE ST
OMAHA NE
68134-6126
US

IV. Provider business mailing address

8814 MAPLE ST
OMAHA NE
68134-6126
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-9100
  • Fax: 402-620-6651
Mailing address:
  • Phone: 402-391-9100
  • Fax: 402-620-6651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SOUBRATA V RAIKAR
Title or Position: CEO
Credential: MD
Phone: 402-981-4768