Provider Demographics
NPI:1720058688
Name:SURGICENTER OF NORFOLK, LLC
Entity Type:Organization
Organization Name:SURGICENTER OF NORFOLK, LLC
Other - Org Name:FOUNTAIN POINT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-379-5555
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:844-698-9578
Mailing Address - Fax:605-274-6186
Practice Address - Street 1:3901 W NORFOLK AVE STE L
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-9218
Practice Address - Country:US
Practice Address - Phone:402-379-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEASC023261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical