Provider Demographics
NPI:1487749230
Name:OMAHA FOOT CARE CENTER INC
Entity type:Organization
Organization Name:OMAHA FOOT CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PODIATRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LUECK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-572-0423
Mailing Address - Street 1:6659 SORENSEN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-2139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6659 SORENSEN PARKWAY
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2139
Practice Address - Country:US
Practice Address - Phone:402-572-0423
Practice Address - Fax:402-572-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1501973Medicaid
526929AOtherPRINCIPAL HEALTH CARE
UI0900712OtherEXCLUSIVE CARE
27 00096OtherUNITED HEALTH CARE
D2526OtherBCBS NE
NE=========00Medicaid
========= A0001OtherTRICARE
4231260001Medicare NSC
UI0900712OtherEXCLUSIVE CARE
U76937Medicare UPIN
========= A0001OtherTRICARE