# GRAND ISLAND SURGICAL CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316940539
- **Authorized official:** MR. KEN TERRY (ADMINISTRATOR)
- **Authorized official phone:** (308) 384-6400

## Contact information

- **Practice address:** 3610 RICHMOND CIR, GRAND ISLAND, NE 68803-3927
- **Practice address phone:** (308) 384-6400
- **Practice address fax:** (308) 398-6420
- **Mailing address:** PO BOX 5434, GRAND ISLAND, NE 68802-5434
- **Mailing address phone:** (308) 384-6400
- **Mailing address fax:** (308) 398-6420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | ASC008 | NE | Yes |

## Other

- **Enumeration date:** 05/23/2005
- **Last updated:** 06/23/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01383 | BCBS PROVIDER ID | NE |
| 01 | — | 490004345 | MEDICARE RR PROVIDER ID | NE |