Provider Demographics
NPI:1598744732
Name:MIDWEST EYE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MIDWEST EYE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EMIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-552-2020
Mailing Address - Street 1:4353 DODGE ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2709
Mailing Address - Country:US
Mailing Address - Phone:402-552-2020
Mailing Address - Fax:402-552-2367
Practice Address - Street 1:4353 DODGE ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2709
Practice Address - Country:US
Practice Address - Phone:402-552-2020
Practice Address - Fax:402-552-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEASC016261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0534699Medicaid
IA0534699Medicaid
NE098943MIMedicare ID - Type Unspecified