Provider Demographics
NPI:1477722445
Name:MIDWEST ORTHOTIC & TECHNOLOGY CENTER OMAHA, LLC
Entity Type:Organization
Organization Name:MIDWEST ORTHOTIC & TECHNOLOGY CENTER OMAHA, LLC
Other - Org Name:TRUST ORTHOTIC TECHNOLOGIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:VELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:574-233-3352
Mailing Address - Street 1:17530 DUGDALE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11225 DAVENPORT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2641
Practice Address - Country:US
Practice Address - Phone:402-933-3942
Practice Address - Fax:402-964-2926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST ORTHOTIC SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-25
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1--25653000Medicaid
NE6082700002Medicare NSC