Provider Demographics
NPI:1013122571
Name:MIDWEST SURGICAL HOSPITAL, L.L.C.
Entity Type:Organization
Organization Name:MIDWEST SURGICAL HOSPITAL, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:6128 S LYNCREST AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2560
Mailing Address - Country:US
Mailing Address - Phone:855-327-6350
Mailing Address - Fax:605-274-6186
Practice Address - Street 1:7915 FARNAM DR.
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4504
Practice Address - Country:US
Practice Address - Phone:402-399-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025662300Medicaid
NE613763400OtherUS DEPARTMENT OF LABOR
IA1013122571Medicaid
NE60236OtherBLUE CROSS OF NEBRASKA
NE10025662300Medicaid