Provider Demographics
NPI:1437607298
Name:ADVANCED FOOT & ANKLE LLC
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-345-6503
Mailing Address - Street 1:3213 SOUTH 24TH STREET
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-1832
Mailing Address - Country:US
Mailing Address - Phone:402-345-6503
Mailing Address - Fax:402-345-0309
Practice Address - Street 1:3213 SOUTH 24TH STREET
Practice Address - Street 2:SUITE 101B
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1832
Practice Address - Country:US
Practice Address - Phone:402-345-6503
Practice Address - Fax:402-345-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE164213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty