Provider Demographics
NPI:1770739773
Name:MIDPLAINS PODIATRY
Entity type:Organization
Organization Name:MIDPLAINS PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KLAWITTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-315-4344
Mailing Address - Street 1:11071 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2604
Mailing Address - Country:US
Mailing Address - Phone:402-315-4344
Mailing Address - Fax:402-315-4343
Practice Address - Street 1:3346 N 108TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-2905
Practice Address - Country:US
Practice Address - Phone:402-315-4344
Practice Address - Fax:402-315-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE280261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEU86379Medicare UPIN
NE6210420001Medicare NSC
NA1168Medicare PIN