Basic Information
| Provider Information | |||||||||
| NPI: | 1780735340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHUTT | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8005 FARNAM DR | ||||||||
| Address2: | STE 305 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023904111 | ||||||||
| FaxNumber: | 4023998455 | ||||||||
| Practice Location | |||||||||
| Address1: | 16120 W DODGE RD | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681182049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023540707 | ||||||||
| FaxNumber: | 4023540711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 94-06441 | KS | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | M10971 | ID | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | 25923 | NE | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 207X00000X | 25923 | NE | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 47068731751 | 05 | NE | MEDICAID | 1780735340 | 05 | IA | MEDICAID | 47068731742 | 05 | NE | MEDICAID |