Provider Demographics
NPI:1134270416
Name:ADVANCED FOOT & ANKLE PC
Entity type:Organization
Organization Name:ADVANCED FOOT & ANKLE PC
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 S 24TH ST
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 S 24TH ST
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:2007-01-15
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE164261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0511113OtherIOWA MEDICAID
NE349957400OtherU S DEPARTMENT OF LABOR
NE87404OtherCOVENTRY HEALTHCARE NEBRA
1049740001OtherDMERC
NE480018212OtherRAILROAD MEDICARE
NE27-00158OtherUNITEDHEALTHCARE
CU0388OtherRR MEDICARE
NE02584OtherBLUECROSSBLUESHIELD
NE=========OtherTRICARE FOR LIFE
NE27-00158OtherUNITEDHEALTHCARE
NE=========OtherMIDLANDS CHOICE
NE=========00Medicaid
1049740001OtherDMERC
NE=========OtherCIGNA HEALTHCARE
1049740001Medicare NSC