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General NPI Number Information
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NPI Number | 1992197669
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Entity Type | Organization
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Legal Business Name | NORFOLK PODIATRY CENTER,LLC
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 1310 N 13TH ST STE 2
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City | NORFOLK
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State | NE
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Zip | 68701-2592
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Country | US
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Telephone | 402-371-5300
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Fax | 844-224-9500
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Provider Business Mailing Address
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Address Line | 1310 N 13TH ST STE 2
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City | NORFOLK
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State | NE
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Zip | 68701-2592
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Country | US
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Telephone | 402-371-5300
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Fax | 844-224-9500
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Authorized Official
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Title or Position | OWNER
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Name | DR. BLAYNE H MCCAFFREY
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Credential | D.P.M.
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Telephone | 402-371-5530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 352
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License Number State | NE
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