Organization
FOUNTAIN FOOT CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE MEIER FOUNTAIN D.P.M. (OWNER)
(402) 466-5677
Entity
Organization
Contact information
Practice address
5835 VINE ST, LINCOLN, NE 68505-2847
(402) 466-5677
Mailing address
5835 VINE ST, PO BOX 5505, LINCOLN, NE 68505-2847
(402) 466-5677
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
218
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480013496
RR MC
NE
05
—
505963785
—
NE
Enumeration date
06/05/2007
Last updated
08/22/2020
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