Healthcare Provider Details

I. General information

NPI: 1427348838
Provider Name (Legal Business Name): NEBRASKA LOWER EXTREMITY SURGERY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 SAMSON WAY
BELLEVUE NE
68123-4307
US

IV. Provider business mailing address

2705 SAMSON WAY
BELLEVUE NE
68123-4307
US

V. Phone/Fax

Practice location:
  • Phone: 402-331-6387
  • Fax: 402-331-6537
Mailing address:
  • Phone: 402-331-6387
  • Fax: 402-331-6537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: CHAD A SUMMY
Title or Position: OWNER/OFFICIAL
Credential: DPM
Phone: 402-331-6387