MEDICARE: FOOT CARE CENTER, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	226	NE

General Provider Information

NPI Number	:	1063741114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT CARE CENTER, PC

Provider Business Mailing Address
First Line	:	1540 NORTH BELL STREET
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-3537
Country	:	US
Telephone Number	:	402-721-7171
Fax Number	:	402-721-7233

Provider Business Practice Location Address
First Line	:	1540 NORTH BELL STREET
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-3537
Country	:	US
Telephone Number	:	402-721-7171
Fax Number	:	402-721-7233

Authorized Official
Title or Position	:	DOCTOR OF PODIATRIC MEDICINE
Name	:	CHARLES M HALVERSON
Credential	:	DPM
Telephone Number	:	402-721-7171

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	04/11/2026

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