# DAVENPORT SURGICAL LLC

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

## Provider details

- **NPI number:** 1548867682
- **Authorized official:** JENNY BRAGANZA (CREDENTIALING MANAGER)
- **Authorized official phone:** (562) 414-4222

## Contact information

- **Practice address:** 17838 BURKE ST STE 101, OMAHA, NE 68118-2256
- **Practice address phone:** (402) 739-8146
- **Mailing address:** 17838 BURKE ST STE 101, OMAHA, NE 68118-2256
- **Mailing address phone:** (402) 739-8146

## Taxonomy

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

## Other

- **Enumeration date:** 10/01/2020
- **Last updated:** 10/01/2020