Provider Demographics
NPI:1033186309
Name:BURT, CHARLES F (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:BURT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 S 144TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5253
Mailing Address - Country:US
Mailing Address - Phone:402-637-0800
Mailing Address - Fax:402-637-0808
Practice Address - Street 1:2725 S 144TH ST STE 212
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5253
Practice Address - Country:US
Practice Address - Phone:402-637-0800
Practice Address - Fax:402-637-0808
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-33081207X00000X, 207XX0005X
NE19725207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33659OtherWELLMARK-CLARINDA
IA38582OtherWELLMARK-ONE EDMUNDSON
NE200034544OtherRAILROAD MEDICARE
IA0900865OtherAMERICHOICE-ONE EDMUNDSON
NE47602554412Medicaid
NE47602554420Medicaid
IA200046164OtherRAILROAD MEDICARE
IA6514695Medicaid
NE0900222OtherAMERICHOICE-2725 S 144
IA4514695Medicaid
IA0514695Medicaid
NE10025238600Medicaid
NE0900221OtherAMERICHOICE-4239 FARNAM
NE10025238600Medicaid
NE271092Medicare ID - Type Unspecified