Provider Demographics
NPI:1992197669
Name:NORFOLK PODIATRY CENTER,LLC
Entity Type:Organization
Organization Name:NORFOLK PODIATRY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAYNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCAFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-371-5530
Mailing Address - Street 1:1310 N 13TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2592
Mailing Address - Country:US
Mailing Address - Phone:402-371-5300
Mailing Address - Fax:844-224-9500
Practice Address - Street 1:1310 N 13TH ST STE 2
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2592
Practice Address - Country:US
Practice Address - Phone:402-371-5300
Practice Address - Fax:844-224-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE352213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty