MEDICARE: PLASTIC SURGICAL ARTS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CG2908	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1013936012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLASTIC SURGICAL ARTS PC

Provider Business Mailing Address
First Line	:	4400 LUCILE DR STE 103
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-4211
Country	:	US
Telephone Number	:	402-483-2572
Fax Number	:	402-483-2619

Provider Business Practice Location Address
First Line	:	4400 LUCILE DR STE 103
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-4211
Country	:	US
Telephone Number	:	402-483-2572
Fax Number	:	402-483-2619

Authorized Official
Title or Position	:	MANAGER
Name	:	TINA OLIVARES
Credential	:
Telephone Number	:	402-483-2572

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	10/31/2024

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Directions to “PLASTIC SURGICAL ARTS PC ” Practice Location

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