Provider Demographics
NPI:1497083422
Name:MIDWEST FOOT & ANKLE, P.C.
Entity Type:Organization
Organization Name:MIDWEST FOOT & ANKLE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-933-8540
Mailing Address - Street 1:7643 CASS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3623
Mailing Address - Country:US
Mailing Address - Phone:402-933-8540
Mailing Address - Fax:402-933-8578
Practice Address - Street 1:7643 CASS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3623
Practice Address - Country:US
Practice Address - Phone:402-933-8540
Practice Address - Fax:402-933-8578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE304261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025816600Medicaid
NE27025OtherBS PROVIDER
NE10025816600Medicaid
NENA1487Medicare PIN