Provider Demographics
NPI:1902090988
Name:NORFOLK PODIATRY PC
Entity Type:Organization
Organization Name:NORFOLK PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:P
Authorized Official - Last Name:STRAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-371-7680
Mailing Address - Street 1:110 N 16TH ST STE 18
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3671
Mailing Address - Country:US
Mailing Address - Phone:402-371-7680
Mailing Address - Fax:402-644-7245
Practice Address - Street 1:110 N 16TH ST STE 18
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3671
Practice Address - Country:US
Practice Address - Phone:402-371-7680
Practice Address - Fax:402-644-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE283213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========07Medicaid
NE192090988Medicare PIN
NEU71462Medicare UPIN
NE=========07Medicaid