# SOUTH OMAHA SURGICAL CENTER LLC

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

## Provider details

- **NPI number:** 1942697735
- **Authorized official:** MR. DANIEL W BORVAN CRNA (VICE PRESIDENT)
- **Authorized official phone:** (708) 253-7258

## Contact information

- **Practice address:** 3201 S 24TH ST, OMAHA, NE 68108-1825
- **Practice address phone:** (402) 504-4071
- **Practice address fax:** (402) 504-4124
- **Mailing address:** 21120 WASHINGTON PKWY, FRANKFORT, IL 60423-3112
- **Mailing address phone:** (815) 469-9750
- **Mailing address fax:** (815) 469-9752

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | ASC068 | NE | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/20/2015
- **Last updated:** 10/09/2017