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Organization
DAVENPORT SURGICAL LLC
Active
Organization
DAVENPORT SURGICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNY BRAGANZA (CREDENTIALING MANAGER)
(562) 414-4222
Entity
Organization
Contact information
Practice address
17838 BURKE ST STE 101, OMAHA, NE 68118-2256
(402) 739-8146
Mailing address
17838 BURKE ST STE 101, OMAHA, NE 68118-2256
(402) 739-8146
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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