Organization
SURGICAL ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOEL MASON GUSTAFSON (ADMINISTRATOR)
(402) 441-4760
Entity
Organization
Contact information
Practice address
1001 S 70TH ST STE 100, LINCOLN, NE 68510-7901
(402) 441-4760
(402) 441-4764
Mailing address
1001 S 70TH ST STE 100, LINCOLN, NE 68510-7901
(402) 441-4760
(402) 441-4764
Taxonomy
Speciality
Code
Description
License number
State
207RB0002X
Obesity Medicine (Internal Medicine) Physician
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025389300
—
NE
05
—
200385800A
—
KS
01
—
30119
BCBS GROUP
NE
Enumeration date
06/19/2006
Last updated
02/12/2019
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