Provider Demographics
NPI:1184699878
Name:NOC SURGERY CENTER LLC
Entity type:Organization
Organization Name:NOC SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-436-2000
Mailing Address - Street 1:6900 A ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4120
Mailing Address - Country:US
Mailing Address - Phone:402-436-2000
Mailing Address - Fax:402-436-2090
Practice Address - Street 1:6900 A ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4120
Practice Address - Country:US
Practice Address - Phone:402-436-2012
Practice Address - Fax:402-434-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE349989600OtherWORKERS COMP US DEPT LABO
NE01199OtherBLUE CROSS BLUE SHIELD
NE123108OtherCOVENTRY
NE490005500OtherRAILROAD MEDICARE
NE123108OtherCOVENTRY
NE349989600OtherWORKERS COMP US DEPT LABO
NE099252Medicare PIN