Provider Demographics
NPI:1609185230
Name:SOCORO LLC
Entity type:Organization
Organization Name:SOCORO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:B
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-933-0400
Mailing Address - Street 1:2510 BELLEVUE MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1520
Mailing Address - Country:US
Mailing Address - Phone:402-991-7832
Mailing Address - Fax:402-991-7981
Practice Address - Street 1:2510 BELLEVUE MEDICAL CENTER DR
Practice Address - Street 2:SUITE 170
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1520
Practice Address - Country:US
Practice Address - Phone:402-670-8903
Practice Address - Fax:402-991-7981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R.E.M. SLEEP CENTER OF BELLEVUE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-30
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic