1730325390 NPI number — TROTTER ENTERPRISES INC

Table of content: (NPI 1730325390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730325390 NPI number — TROTTER ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TROTTER ENTERPRISES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMPLETE FAMILY FOOT CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730325390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67035
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-7035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-423-0762
Provider Business Mailing Address Fax Number:
844-515-5148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 S 70TH ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68510-7901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-423-0762
Provider Business Practice Location Address Fax Number:
844-515-5148
Provider Enumeration Date:
12/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TROTTER
Authorized Official First Name:
SYLVIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
402-423-0762

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  311 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10025715400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00690628 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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