Healthcare Provider Details

I. General information

NPI: 1679953392
Provider Name (Legal Business Name): LINCOLN FOOT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N COTNER BLVD SUITE 116
LINCOLN NE
68505
US

IV. Provider business mailing address

600 N COTNER BLVD SUITE 116
LINCOLN NE
68505-2343
US

V. Phone/Fax

Practice location:
  • Phone: 402-466-6677
  • Fax: 402-466-6724
Mailing address:
  • Phone: 402-466-6677
  • Fax: 402-466-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNE

VIII. Authorized Official

Name: MATTHEW R. HAHNE
Title or Position: PRESIDENT
Credential: DPM
Phone: 402-466-6677