Provider Demographics
NPI:1871795211
Name:PLASTIC SURGICAL CENTER
Entity type:Organization
Organization Name:PLASTIC SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-552-2200
Mailing Address - Street 1:4239 FARNAM ST STE 219
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2803
Mailing Address - Country:US
Mailing Address - Phone:402-552-2200
Mailing Address - Fax:402-552-2207
Practice Address - Street 1:4239 FARNAM ST
Practice Address - Street 2:#219
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2868
Practice Address - Country:US
Practice Address - Phone:402-552-2200
Practice Address - Fax:402-552-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12515174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========13Medicaid
NE087075BLMedicare ID - Type Unspecified