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General NPI Number Information
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NPI Number | 1649489832
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Entity Type | Organization
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Legal Business Name | FREMONT SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 840 E 29TH STREET
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City | FREMONT
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State | NE
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Zip | 68025
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Country | US
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Telephone | 402-941-7050
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Fax | 402-941-7055
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Provider Business Mailing Address
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Address Line | 840 E 29TH STREET
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City | FREMONT
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State | NE
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Zip | 68025
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Country | US
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Telephone | 402-941-7050
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Fax | 402-941-7055
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | STEPHEN P HENRY
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Credential |
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Telephone | 402-941-7050
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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 |
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | ASC052
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License Number State | NE
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