Provider Demographics
NPI:1629076302
Name:COLON AND RECTAL SURGERY INC
Entity Type:Organization
Organization Name:COLON AND RECTAL SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-1122
Mailing Address - Street 1:9850 NICHOLAS STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-343-1122
Mailing Address - Fax:402-343-1177
Practice Address - Street 1:985 NICHOLAS STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-343-1122
Practice Address - Fax:402-343-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01922OtherBCBS OF NEBRASKA
IA0937912Medicaid
IA93791OtherBCBS OF IOWA WELLMARK
CH7569OtherRR MEDICARE PALMETO GPA
NE01922OtherBCBS OF NEBRASKA
NE095972Medicare PIN