Provider Demographics
NPI:1467490433
Name:UROLOGY SURGICAL CENTER LLC
Entity type:Organization
Organization Name:UROLOGY SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-489-8888
Mailing Address - Street 1:5500 PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3389
Mailing Address - Country:US
Mailing Address - Phone:402-421-8899
Mailing Address - Fax:402-421-8950
Practice Address - Street 1:5500 PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3389
Practice Address - Country:US
Practice Address - Phone:402-421-8899
Practice Address - Fax:402-421-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEASC028261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6800029OtherUNITED HEALTHCARE
NE01082OtherBLUECROSS BLUE SHIELD PPO
NEF1023OtherMIDLANDS CHOICE
NE6800029OtherUNITED HEALTHCARE
NEF1023OtherMIDLANDS CHOICE
NE=========00Medicaid