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Organization
STAR CITY COSMETIC SURGERY LLC
Active
Organization
STAR CITY COSMETIC SURGERY LLC
Active
Other names
Jacobson Cosmetic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA PAIGE JACOBSON DO (PHYSICIAN/OWNER)
(402) 890-6249
Entity
Organization
Contact information
Practice address
1630 S 70TH ST STE 202, LINCOLN, NE 68506-1500
(531) 254-5458
(531) 254-5065
Mailing address
1630 S 70TH ST STE 202, LINCOLN, NE 68506-1500
(531) 254-5458
(531) 254-5065
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
—
NULL
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
NULL
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
261QM2500X
Medical Specialty Clinic/Center
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017014908
STATE MEDICAL LICENSE
MO
01
—
2369
STATE MEDICAL LICENSE
NE
Enumeration date
11/10/2021
Last updated
02/10/2022
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