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General NPI Number Information
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NPI Number | 1669138905
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Entity Type | Organization
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Legal Business Name | STAR CITY COSMETIC SURGERY LLC
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 1630 S 70TH ST STE 202
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City | LINCOLN
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State | NE
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Zip | 68506-1500
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Country | US
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Telephone | 531-254-5458
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Fax | 531-254-5065
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Provider Business Mailing Address
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Address Line | 1630 S 70TH ST STE 202
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City | LINCOLN
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State | NE
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Zip | 68506-1500
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Country | US
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Telephone | 531-254-5458
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Fax | 531-254-5065
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. JESSICA PAIGE JACOBSON
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Credential | DO
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Telephone | 402-890-6249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State |
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