Provider Demographics
NPI:1285214049
Name:INNOVATIVE SURGICAL SOLUTIONS LLC
Entity type:Organization
Organization Name:INNOVATIVE SURGICAL SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-564-7118
Mailing Address - Street 1:3772 43RD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1681
Mailing Address - Country:US
Mailing Address - Phone:402-562-8795
Mailing Address - Fax:402-563-2765
Practice Address - Street 1:3772 43RD AVE STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1681
Practice Address - Country:US
Practice Address - Phone:402-562-8795
Practice Address - Fax:402-563-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical