MEDICARE: NORTHWOODS SURGERY CENTER LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35516	OTHER	NE	BCBS OF NEBRASKA

General Provider Information

NPI Number	:	1972557635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWOODS SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	7441 O ST
Second Line	:	SUITE 201
City	:	LINCOLN
State	:	NE
Zip	:	68510-2468
Country	:	US
Telephone Number	:	402-483-4485
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 N 83RD ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-2080
Country	:	US
Telephone Number	:	402-483-4485
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. JOHN TENNITY
Credential	:	D.P.M.
Telephone Number	:	402-483-4485

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	02/22/2008

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