Healthcare Provider Details

I. General information

NPI: 1306996152
Provider Name (Legal Business Name): ASSOCIATED PODIATRISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12115 PACIFIC ST
OMAHA NE
68154-3527
US

IV. Provider business mailing address

PO BOX 241259
OMAHA NE
68124-5259
US

V. Phone/Fax

Practice location:
  • Phone: 402-978-5183
  • Fax: 402-341-3616
Mailing address:
  • Phone: 402-978-5183
  • Fax: 402-341-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number195
License Number StateNE

VIII. Authorized Official

Name: MS. NANCI J VIEYRA
Title or Position: BILLING MANAGER
Credential:
Phone: 402-978-5151