Organization
SURGERY CENTER OF FREMONT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
(615) 234-5954
Entity
Organization
Contact information
Practice address
2727 N CLARKSON ST, FREMONT, NE 68025-7713
(402) 727-8500
(402) 721-1065
Mailing address
2727 N CLARKSON ST, FREMONT, NE 68025-7713
(402) 727-8500
(402) 721-1065
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
ASC007
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002537100
—
NE
01
—
P00302981
RR MEDICARE
—
Enumeration date
05/19/2006
Last updated
10/28/2022
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