# STAR CITY COSMETIC SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jacobson Cosmetic Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669138905
- **Authorized official:** DR. JESSICA PAIGE JACOBSON DO (PHYSICIAN/OWNER)
- **Authorized official phone:** (402) 890-6249

## Contact information

- **Practice address:** 1630 S 70TH ST STE 202, LINCOLN, NE 68506-1500
- **Practice address phone:** (531) 254-5458
- **Practice address fax:** (531) 254-5065
- **Mailing address:** 1630 S 70TH ST STE 202, LINCOLN, NE 68506-1500
- **Mailing address phone:** (531) 254-5458
- **Mailing address fax:** (531) 254-5065

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | — | NULL | Yes |
| 207YS0123X | Facial Plastic Surgery Physician | — | — | Yes |
| 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

- **Enumeration date:** 11/10/2021
- **Last updated:** 02/10/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2017014908 | STATE MEDICAL LICENSE | MO |
| 01 | — | 2369 | STATE MEDICAL LICENSE | NE |