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General NPI Number Information
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NPI Number | 1053366930
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Entity Type | Organization
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Legal Business Name | ADVANCED SURGERY CENTER, LLC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 111 S 10TH ST
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City | OMAHA
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State | NE
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Zip | 68102-1104
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Country | US
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Telephone | 402-345-1712
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Fax | 402-345-1864
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Provider Business Mailing Address
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Address Line | 111 S 10TH ST
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City | OMAHA
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State | NE
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Zip | 68102-1104
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Country | US
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Telephone | 402-345-1712
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Fax | 402-345-1864
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Authorized Official
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Title or Position | OFFICER AND AUTHORIZED OFFICIAL
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Name | JENNIFER BOYD BALDOCK
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Credential |
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Telephone | 615-234-5954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | ASC042
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License Number State | NE
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