South Omaha Surgical Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

ASC068 Issued in NE

Legal business name

SOUTH OMAHA SURGICAL CENTER LLC

Practice address

3201 S 24TH St
Omaha, NE 68108-1825

Phone

(402) 504-4071

Fax

(402) 504-4124

NPI assigned

Apr 20, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Daniel W Borvan, CRNANPI 1962404442

Title

Vice President

Phone

(708) 253-7258

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel W. Borvan, CRNA

  • Certified Registered Nurse Anesthetist
  • Chicago, IL
  • NPI 1962404442
  NPD Authorized official

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

{
    "created_epoch": "1429488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507507200000",
    "number": "1942697735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21120 WASHINGTON PKWY",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604233112",
            "telephone_number": "815-469-9750",
            "fax_number": "815-469-9752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 S 24TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681081825",
            "telephone_number": "402-504-4071",
            "fax_number": "402-504-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH OMAHA SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-20",
        "last_updated": "2017-10-09",
        "status": "A",
        "authorized_official_last_name": "BORVAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "708-253-7258",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NE",
            "license": "ASC068",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Source One Medical Inc
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• Grace Ellen Sourile, RD
• South 73 Dental LLC
• South Omaha Medical Associates
• Ian South, MD
• Natasha R Southall
• Southern Sudan Comm Ass
• Southside Chiropractic
• Southside Healthcare, Inc.

• 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 9, 2017; 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.