Organization
COLON AND RECTAL SURGERY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDY STOCKTON (PRACTICE ADMINISTRATOR)
(402) 343-1122
Entity
Organization
Contact information
Practice address
985 NICHOLAS STREET, SUITE 100, OMAHA, NE 68114
(402) 343-1122
(402) 343-1177
Mailing address
9850 NICHOLAS STREET, SUITE 100, OMAHA, NE 68114
(402) 343-1122
(402) 343-1177
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
—
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01922
BCBS OF NEBRASKA
NE
05
—
0937912
—
IA
01
—
93791
BCBS OF IOWA WELLMARK
IA
01
—
CH7569
RR MEDICARE PALMETO GPA
—
Enumeration date
07/07/2005
Last updated
07/21/2022
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