Provider Demographics
NPI:1861497380
Name:NORTHEAST NEBRASKA SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NORTHEAST NEBRASKA SURGERY CENTER LLC
Other - Org Name:FAITH REGIONAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER OF BOARD OF MANAGERS
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-644-7637
Mailing Address - Street 1:2701 W NORFOLK AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4408
Mailing Address - Country:US
Mailing Address - Phone:402-644-7262
Mailing Address - Fax:402-644-7227
Practice Address - Street 1:2701 W NORFOLK AVE
Practice Address - Street 2:STE 101
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4408
Practice Address - Country:US
Practice Address - Phone:402-644-7262
Practice Address - Fax:402-644-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0719674Medicaid
NEF885OtherMIDLANDS CHOICE
NE01307OtherBCBS
NE490004329OtherRR MEDICARE
IA0719674Medicaid
NE=========00Medicaid
IA0719674Medicaid