Provider Demographics
NPI:1407946650
Name:SOUTHEAST NEBRASKA SURGERY P.C.
Entity Type:Organization
Organization Name:SOUTHEAST NEBRASKA SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-228-4236
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:1110 JACKSON ST
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-0128
Mailing Address - Country:US
Mailing Address - Phone:402-228-4236
Mailing Address - Fax:402-228-4668
Practice Address - Street 1:1110 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2117
Practice Address - Country:US
Practice Address - Phone:402-228-4236
Practice Address - Fax:402-228-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid