Provider Demographics
NPI:1013984665
Name:POPP COSMETIC SURGERY PC
Entity Type:Organization
Organization Name:POPP COSMETIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:POPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-391-4558
Mailing Address - Street 1:11919 GRANT ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3475
Mailing Address - Country:US
Mailing Address - Phone:402-391-4558
Mailing Address - Fax:402-391-7401
Practice Address - Street 1:11919 GRANT ST
Practice Address - Street 2:STE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3475
Practice Address - Country:US
Practice Address - Phone:402-391-4558
Practice Address - Fax:402-391-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
F235478OtherMIDLANDS CHOICE
NE01644OtherBLUECROSS BLUESHIELD
F235478OtherMIDLANDS CHOICE
NE=========01Medicaid