Provider Demographics
NPI:1942306816
Name:OMEGA SURGERY CENTER LLC
Entity Type:Organization
Organization Name:OMEGA SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAO
Authorized Official - Middle Name:JANG
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-493-2020
Mailing Address - Street 1:755 FALLBROOK BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-9055
Mailing Address - Country:US
Mailing Address - Phone:402-483-4448
Mailing Address - Fax:402-483-4750
Practice Address - Street 1:11606 NICHOLAS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4478
Practice Address - Country:US
Practice Address - Phone:402-493-3712
Practice Address - Fax:402-493-8341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMEGA SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-16
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099872Medicare PIN