Provider Demographics
NPI:1922642412
Name:OMAHA FACIAL PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:OMAHA FACIAL PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-882-7722
Mailing Address - Street 1:17838 BURKE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2256
Mailing Address - Country:US
Mailing Address - Phone:402-882-7722
Mailing Address - Fax:402-739-8146
Practice Address - Street 1:17838 BURKE ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2256
Practice Address - Country:US
Practice Address - Phone:402-882-7722
Practice Address - Fax:402-739-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty