Provider Demographics
NPI: | 1528026788 |
---|---|
Name: | LAKESIDE AMBULATORY SURGICAL CENTER LLC |
Entity Type: | Organization |
Organization Name: | LAKESIDE AMBULATORY SURGICAL CENTER LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | BUSINESS OFFICE MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | VICKIE |
Authorized Official - Middle Name: | GAIL |
Authorized Official - Last Name: | PERRY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 402-758-5211 |
Mailing Address - Street 1: | 17030 LAKESIDE HILLS PLZ |
Mailing Address - Street 2: | SUITE 206 |
Mailing Address - City: | OMAHA |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68130-2396 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 402-758-5120 |
Mailing Address - Fax: | 402-758-5087 |
Practice Address - Street 1: | 17030 LAKESIDE HILLS PLZ |
Practice Address - Street 2: | SUITE 206 |
Practice Address - City: | OMAHA |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68130-2396 |
Practice Address - Country: | US |
Practice Address - Phone: | 402-758-5120 |
Practice Address - Fax: | 402-758-5087 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-03 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |