Healthcare Provider Details

I. General information

NPI: 1609855568
Provider Name (Legal Business Name): BELLEVUE FOOT CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 S WASHINGTON ST STE 270
PAPILLION NE
68046-4193
US

IV. Provider business mailing address

1413 S WASHINGTON ST STE 270
PAPILLION NE
68046-4193
US

V. Phone/Fax

Practice location:
  • Phone: 402-291-3123
  • Fax: 402-291-1560
Mailing address:
  • Phone: 402-291-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number186
License Number StateNE

VIII. Authorized Official

Name: JONATHAN MICHAEL LITTLE
Title or Position: OWNER/PODIATRIST
Credential: DPM
Phone: 402-291-3123