Provider Demographics
NPI:1306843081
Name:SKIN SPECIALISTS PC
Entity Type:Organization
Organization Name:SKIN SPECIALISTS PC
Other - Org Name:ADVANCED CENTER FOR SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLESSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-334-7546
Mailing Address - Street 1:2802 OAK VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5604
Mailing Address - Country:US
Mailing Address - Phone:402-334-7546
Mailing Address - Fax:402-334-8627
Practice Address - Street 1:2802 OAK VIEW DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5604
Practice Address - Country:US
Practice Address - Phone:402-334-7546
Practice Address - Fax:402-334-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE266174261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03079OtherBLUE CROSS BLUE SHIELD
NE=========09Medicaid
NE03079OtherBLUE CROSS BLUE SHIELD
NE=========09Medicaid