=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073865168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FACIAL SURGERY INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2012
-----------------------------------------------------
Last Update Date | 10/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2727 S 144TH ST SUITE 235
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68144-5225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-330-8460
-----------------------------------------------------
Fax | 402-330-8497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2727 S 144TH ST SUITE 235
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68144-5225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-330-8460
-----------------------------------------------------
Fax | 402-330-8497
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/CO OWNER
-----------------------------------------------------
Name | BRUCE KUHN
-----------------------------------------------------
Credential | MD DDS
-----------------------------------------------------
Telephone | 402-330-8460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------