Provider Demographics
NPI:1215815485
Name:OMAHA CHILDREN'S SURGERY CENTER LLC
Entity type:Organization
Organization Name:OMAHA CHILDREN'S SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-340-1840
Mailing Address - Street 1:9709 LAKESIDE BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1216
Mailing Address - Country:US
Mailing Address - Phone:713-489-2198
Mailing Address - Fax:713-489-2978
Practice Address - Street 1:2727 S 144TH ST STE 180
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5225
Practice Address - Country:US
Practice Address - Phone:402-513-0318
Practice Address - Fax:402-509-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical