Provider Demographics
NPI:1558401414
Name:FRED MILLER JAMES
Entity Type:Organization
Organization Name:FRED MILLER JAMES
Other - Org Name:LINCOLN FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-466-6677
Mailing Address - Street 1:600 N COTNER BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2343
Mailing Address - Country:US
Mailing Address - Phone:402-466-6677
Mailing Address - Fax:402-466-6724
Practice Address - Street 1:600 N COTNER BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-466-6677
Practice Address - Fax:402-466-6724
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRED MILLER JAMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE260213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE091248Medicare UPIN
NEU19671Medicare UPIN