Provider Demographics
NPI:1134162910
Name:FOOT & ANKLE CLINIC OF CENTRAL NEBRASKA PC
Entity type:Organization
Organization Name:FOOT & ANKLE CLINIC OF CENTRAL NEBRASKA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:308-381-0404
Mailing Address - Street 1:PO BOX 5020
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5020
Mailing Address - Country:US
Mailing Address - Phone:308-381-0404
Mailing Address - Fax:308-381-0408
Practice Address - Street 1:620 N DIERS AVE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4985
Practice Address - Country:US
Practice Address - Phone:308-381-0404
Practice Address - Fax:308-381-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0152470001Medicare NSC