Healthcare Provider Details

I. General information

NPI: 1285643189
Provider Name (Legal Business Name): CHARLES E SCHOLTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 NORTHWOODS DRIVE
LINCOLN NE
68505-2093
US

IV. Provider business mailing address

PO BOX 67250
LINCOLN NE
68506-7250
US

V. Phone/Fax

Practice location:
  • Phone: 402-466-0555
  • Fax: 402-488-0743
Mailing address:
  • Phone: 402-328-8833
  • Fax: 402-328-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number251
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: