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General NPI Number Information
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NPI Number | 1801831268
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 1001 S 70TH ST STE 100
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City | LINCOLN
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State | NE
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Zip | 68510-7901
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Country | US
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Telephone | 402-441-4760
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Fax | 402-441-4764
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Provider Business Mailing Address
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Address Line | 1001 S 70TH ST STE 100
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City | LINCOLN
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State | NE
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Zip | 68510-7901
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Country | US
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Telephone | 402-441-4760
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Fax | 402-441-4764
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOEL MASON GUSTAFSON
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Credential |
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Telephone | 402-441-4760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) 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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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