1609855568 NPI number — BELLEVUE FOOT CENTER, P.C.

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 1609855568 NPI number — BELLEVUE FOOT CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLEVUE FOOT CENTER, P.C.
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:
1609855568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1413 S WASHINGTON ST STE 270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAPILLION
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68046-4193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-291-3123
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1413 S WASHINGTON ST STE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAPILLION
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68046-4193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-291-3123
Provider Business Practice Location Address Fax Number:
402-291-1560
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LITTLE
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER/PODIATRIST
Authorized Official Telephone Number:
402-291-3123

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  186 , 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: 01946 . This is a "BCBS NE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: CS4192 . This is a "PALMETTO GBA RR MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com