Provider Demographics
NPI:1609886704
Name:OMAHA SURGICAL CONSULTANTS PC
Entity Type:Organization
Organization Name:OMAHA SURGICAL CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROALENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:REDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-758-5250
Mailing Address - Street 1:17030 LAKESIDE HILLS PLZ STE 127
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2396
Mailing Address - Country:US
Mailing Address - Phone:402-758-5250
Mailing Address - Fax:402-758-5255
Practice Address - Street 1:17030 LAKESIDE HILLS PLZ STE 127
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2396
Practice Address - Country:US
Practice Address - Phone:402-758-5250
Practice Address - Fax:402-758-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========OtherTRICARE
NE086990Medicare PIN
IA70084Medicare PIN
NE=========OtherTRICARE
NECE2324Medicare PIN