Basic Information
| Provider Information | |||||||||
| NPI: | 1285643189 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHOLTES | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 67250 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685067250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023288833 | ||||||||
| FaxNumber: | 4023282921 | ||||||||
| Practice Location | |||||||||
| Address1: | 8207 NORTHWOODS DRIVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685052093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024660555 | ||||||||
| FaxNumber: | 4024880743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 05/24/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 251 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 39059 | 01 | NE | BCBS | OTHER |