Davenport Surgical LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

DAVENPORT SURGICAL LLC

Practice address

17838 Burke St Ste 101
Omaha, NE 68118-2256

Phone

(402) 739-8146

NPI assigned

Oct 1, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jenny Braganza

Title

Credentialing Manager

Phone

(562) 414-4222

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1548867682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17838 BURKE ST STE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681182256",
            "telephone_number": "402-739-8146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17838 BURKE ST STE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681182256",
            "telephone_number": "402-739-8146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVENPORT SURGICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-01",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "BRAGANZA",
        "authorized_official_first_name": "JENNY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "562-414-4222"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jateyana Daughtery-Drummond
• Detra Daughtery
• Joan Daughton, M.D.
• Kari Dauner, PLMHP
• Janki Janak Dave
• Amanda Elizabeth Davenport
• Josephine M Davenport, COTA
• Jenna Kristen Davey, PHARMD
• Mary S. Davey, M.D.
• Mathew Alan Davey, M.D.

• Ambulatory Surgical Clinic/Center in Omaha, NE
• Providers in Omaha, NE by specialty
• Ambulatory Surgical Clinic/Center in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.