Provider Demographics
NPI:1780934083
Name:FLORENCE FOOTWORKS, INC.
Entity type:Organization
Organization Name:FLORENCE FOOTWORKS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/SEC
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-453-3300
Mailing Address - Street 1:5102 YEW LN
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-5117
Mailing Address - Country:US
Mailing Address - Phone:402-453-3300
Mailing Address - Fax:402-453-4790
Practice Address - Street 1:640 E 22ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2672
Practice Address - Country:US
Practice Address - Phone:402-721-9428
Practice Address - Fax:402-453-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025285600Medicaid
NE5447600001Medicare NSC