Provider Demographics
NPI:1477151603
Name:PLATTE RIVER FOOT AND ANKLE SURGEONS LLC
Entity Type:Organization
Organization Name:PLATTE RIVER FOOT AND ANKLE SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-751-0600
Mailing Address - Street 1:306 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7532
Mailing Address - Country:US
Mailing Address - Phone:402-751-0600
Mailing Address - Fax:402-751-0800
Practice Address - Street 1:306 W 2ND ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-7532
Practice Address - Country:US
Practice Address - Phone:402-751-0600
Practice Address - Fax:402-751-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty