# LAKESIDE AMBULATORY SURGICAL CENTER LLC

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

## Provider details

- **NPI number:** 1528026788
- **Authorized official:** ALICIA K WAGNER (CEO)
- **Authorized official phone:** (402) 758-5212

## Contact information

- **Practice address:** 17030 LAKESIDE HILLS PLZ STE 110, OMAHA, NE 68130-2440
- **Practice address phone:** (402) 758-5120
- **Practice address fax:** (402) 758-5087
- **Mailing address:** 17030 LAKESIDE HILLS PLZ STE 110, OMAHA, NE 68130-2440
- **Mailing address phone:** (402) 758-5120
- **Mailing address fax:** (402) 758-5087

## Taxonomy

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

## Other

- **Enumeration date:** 05/03/2006
- **Last updated:** 11/13/2025