Provider Demographics
NPI:1831205152
Name:ORTHOPAEDIC SURGICENTER INC
Entity type:Organization
Organization Name:ORTHOPAEDIC SURGICENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VARHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-381-0100
Mailing Address - Street 1:PO BOX 1366
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802
Mailing Address - Country:US
Mailing Address - Phone:308-381-0100
Mailing Address - Fax:
Practice Address - Street 1:810 DIERS AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68802
Practice Address - Country:US
Practice Address - Phone:308-381-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
NEASC033261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024970600Medicaid
NE10024970600Medicaid