Provider Demographics
NPI:1891875175
Name:HEAD AND NECK SURGICAL PARTNERS LLC
Entity Type:Organization
Organization Name:HEAD AND NECK SURGICAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF MANAGERS
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-484-4974
Mailing Address - Street 1:1500 S 48TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1277
Mailing Address - Country:US
Mailing Address - Phone:402-488-5812
Mailing Address - Fax:402-488-1356
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:STE 201
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1277
Practice Address - Country:US
Practice Address - Phone:402-488-5812
Practice Address - Fax:402-488-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEASC022261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-00Medicaid
NE=========-00Medicaid