Provider Demographics
NPI:1720334097
Name:PACIFIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PACIFIC SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUCLID
Authorized Official - Middle Name:
Authorized Official - Last Name:DESOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-391-2166
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:855-334-2955
Mailing Address - Fax:605-274-6186
Practice Address - Street 1:10707 PACIFIC ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4762
Practice Address - Country:US
Practice Address - Phone:402-933-1844
Practice Address - Fax:402-932-5891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2347OtherPTAN