Provider Demographics
NPI:1558766238
Name:MOMENTUM FOOT AND ANKLE WELLNESS CENTER, PC
Entity Type:Organization
Organization Name:MOMENTUM FOOT AND ANKLE WELLNESS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:PALMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-315-4406
Mailing Address - Street 1:3821 N 167TH CT
Mailing Address - Street 2:SUITE 115
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8070
Mailing Address - Country:US
Mailing Address - Phone:402-315-4406
Mailing Address - Fax:
Practice Address - Street 1:3821 N 167TH CT
Practice Address - Street 2:SUITE 115
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-8070
Practice Address - Country:US
Practice Address - Phone:402-315-4406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE342213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty