1578647608 NPI number — FAMILY ORTHOTICS AND PROSTHETICS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578647608 NPI number — FAMILY ORTHOTICS AND PROSTHETICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY ORTHOTICS AND PROSTHETICS 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:
Provider Other Organization Name Type Code:
6
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:
1578647608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEARNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68848-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-338-3550
Provider Business Mailing Address Fax Number:
308-338-3551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 S 59TH ST
Provider Second Line Business Practice Location Address:
SUITE 24
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68516-2398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-438-4340
Provider Business Practice Location Address Fax Number:
402-438-4365
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAVLICEK
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PATIENT ACCOUNTS
Authorized Official Telephone Number:
308-338-3550

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , 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: 0733220 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025443400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: F234568 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 200278950A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08836 . This is a "BCBS OF NE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10024962500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0743112 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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