Provider Demographics
NPI:1609855568
Name:BELLEVUE FOOT CENTER, P.C.
Entity Type:Organization
Organization Name:BELLEVUE FOOT CENTER, P.C.
Other - Org Name:PAPILLION FOOT AND ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-291-3123
Mailing Address - Street 1:1413 S WASHINGTON ST STE 270
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4193
Mailing Address - Country:US
Mailing Address - Phone:402-291-3123
Mailing Address - Fax:
Practice Address - Street 1:1413 S WASHINGTON ST STE 270
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4193
Practice Address - Country:US
Practice Address - Phone:402-291-3123
Practice Address - Fax:402-291-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE186213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01946OtherBCBS NE
CS4192OtherPALMETTO GBA RR MEDICARE
CS4192OtherPALMETTO GBA RR MEDICARE
NE=========00Medicaid
NE0360620001Medicare NSC
NE01946OtherBCBS NE