Provider Demographics
NPI:1114343449
Name:NEBRASKA LOWER EXTREMITY SURGERY GROUP, LLC
Entity Type:Organization
Organization Name:NEBRASKA LOWER EXTREMITY SURGERY GROUP, LLC
Other - Org Name:FOOT AND ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUMMY
Authorized Official - Suffix:
Authorized Official - Credentials:DMP
Authorized Official - Phone:402-991-8999
Mailing Address - Street 1:2705 SAMSON WAY
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4307
Mailing Address - Country:US
Mailing Address - Phone:402-991-8999
Mailing Address - Fax:402-331-6537
Practice Address - Street 1:1301 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-1903
Practice Address - Country:US
Practice Address - Phone:402-991-8999
Practice Address - Fax:402-331-6537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE289213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026123800Medicaid
NE6602330002Medicare NSC