Provider Demographics
NPI:1093979163
Name:POPP COSMETIC SURGERY PC
Entity Type:Organization
Organization Name:POPP COSMETIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:POPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-391-4558
Mailing Address - Street 1:11919 GRANT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3475
Mailing Address - Country:US
Mailing Address - Phone:402-391-4558
Mailing Address - Fax:402-391-7401
Practice Address - Street 1:11919 GRANT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3475
Practice Address - Country:US
Practice Address - Phone:402-391-4558
Practice Address - Fax:402-391-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE150462086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE13-00055OtherUNITED HEALTHCARE
NE497OtherMIDLANDS CHOICE
NE01644OtherBLUECROSS BLUESHIELD
NEF235478OtherMIDLANDS CHOICE
NE180011030OtherRAILROAD MEDICARE
NE03330OtherBLUECROSS BLUESHIELD
NE=========OtherTRICARE
NEF235478OtherMIDLANDS CHOICE
NE497OtherMIDLANDS CHOICE
NEB67895Medicare UPIN
NE=========00Medicaid
NE180011030OtherRAILROAD MEDICARE