Provider Demographics
NPI:1558337790
Name:KEARNEY AMBULATORY SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:KEARNEY AMBULATORY SURGICAL CENTER, LLC
Other - Org Name:HEARTLAND SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELAHUNTY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CNOR
Authorized Official - Phone:308-865-2670
Mailing Address - Street 1:3515 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2298
Mailing Address - Country:US
Mailing Address - Phone:308-865-2670
Mailing Address - Fax:308-865-2876
Practice Address - Street 1:3515 30TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2298
Practice Address - Country:US
Practice Address - Phone:308-865-2670
Practice Address - Fax:308-865-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEASC030261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE35283OtherBLUE CROSS BLUE SHIELD
NE35283OtherBLUE CROSS BLUE SHIELD
NE099036Medicare ID - Type Unspecified