Provider Demographics
NPI:1578647608
Name:FAMILY ORTHOTICS AND PROSTHETICS INC
Entity Type:Organization
Organization Name:FAMILY ORTHOTICS AND PROSTHETICS INC
Other - Org Name:FAMILY ORTHOTICS AND PROSTHETICS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAVLICEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-338-3550
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-1510
Mailing Address - Country:US
Mailing Address - Phone:308-338-3550
Mailing Address - Fax:308-338-3551
Practice Address - Street 1:5550 S 59TH ST
Practice Address - Street 2:SUITE 24
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2398
Practice Address - Country:US
Practice Address - Phone:402-438-4340
Practice Address - Fax:402-438-4365
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY ORTHOTICS & PROSTHETICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0733220Medicaid
NE10025443400Medicaid
NEF234568OtherMIDLANDS CHOICE
KS200278950AMedicaid
NE08836OtherBCBS OF NE
NE10024962500Medicaid
IA0743112Medicaid
NEF234568OtherMIDLANDS CHOICE
NE10025443400Medicaid
NE08836OtherBCBS OF NE
NE4701850005Medicare PIN