Healthcare Provider Details

I. General information

NPI: 1740743368
Provider Name (Legal Business Name): FOOT AND ANKLE CENTER OF NEBRASKA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E BROADWAY
COUNCIL BLUFFS IA
51503-4417
US

IV. Provider business mailing address

9006 OHIO ST STE 1
OMAHA NE
68134-6139
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-7575
  • Fax:
Mailing address:
  • Phone: 402-391-7575
  • Fax: 402-391-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT M GREENHAGEN
Title or Position: OWNER
Credential: DPM
Phone: 402-391-7575