Provider Demographics
NPI:1417050709
Name:COLUMBUS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:COLUMBUS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ GOVERNING BODY
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIEDRICHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-562-8795
Mailing Address - Street 1:3772 43RD AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601
Mailing Address - Country:US
Mailing Address - Phone:402-562-8795
Mailing Address - Fax:402-563-2765
Practice Address - Street 1:3772 43RD AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601
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:2006-09-05
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025549900Medicaid
NE10025549900Medicaid