Provider Demographics
NPI:1508882473
Name:FAMILY ORTHOTICS & PROSTHETICS INC.
Entity Type:Organization
Organization Name:FAMILY ORTHOTICS & PROSTHETICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:VYVLECKA
Authorized Official - Suffix:SR
Authorized Official - Credentials:CO,BOCPO
Authorized Official - Phone:308-338-3550
Mailing Address - Street 1:4005 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1305
Mailing Address - Country:US
Mailing Address - Phone:308-338-3550
Mailing Address - Fax:308-338-3551
Practice Address - Street 1:4005 7TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1305
Practice Address - Country:US
Practice Address - Phone:308-338-3550
Practice Address - Fax:308-338-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08836OtherBCBS OF NE PROV. #
KS200278950AMedicaid
NE10024962500Medicaid
IA0579268Medicaid
NE=========OtherMIDLANDS CHOICE
IA0579268Medicaid
NE10024962500Medicaid
NE10024962500Medicaid