Provider Demographics
NPI:1013936012
Name:PLASTIC SURGICAL ARTS PC
Entity Type:Organization
Organization Name:PLASTIC SURGICAL ARTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-483-2573
Mailing Address - Street 1:4400 LUCILE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4211
Mailing Address - Country:US
Mailing Address - Phone:402-483-2572
Mailing Address - Fax:402-483-2619
Practice Address - Street 1:4400 LUCILE DR STE 103
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4211
Practice Address - Country:US
Practice Address - Phone:402-483-2572
Practice Address - Fax:402-483-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG2908OtherRAILROAD MEDICARE
NE=========13Medicaid
NE=========13Medicaid