Healthcare Provider Details

I. General information

NPI: 1013122571
Provider Name (Legal Business Name): MIDWEST SURGICAL HOSPITAL, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 FARNAM DR.
OMAHA NE
68114-4504
US

IV. Provider business mailing address

6128 S LYNCREST AVE
SIOUX FALLS SD
57108-2560
US

V. Phone/Fax

Practice location:
  • Phone: 402-399-1900
  • Fax:
Mailing address:
  • Phone: 855-327-6350
  • Fax: 605-274-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BOYD BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954