Healthcare Provider Details

I. General information

NPI: 1114343449
Provider Name (Legal Business Name): NEBRASKA LOWER EXTREMITY SURGERY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N 72ND ST
OMAHA NE
68114-1903
US

IV. Provider business mailing address

2705 SAMSON WAY
BELLEVUE NE
68123-4307
US

V. Phone/Fax

Practice location:
  • Phone: 402-991-8999
  • Fax: 402-331-6537
Mailing address:
  • Phone: 402-991-8999
  • Fax: 402-331-6537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number289
License Number StateNE

VIII. Authorized Official

Name: CHAD A SUMMY
Title or Position: OWNER
Credential: DMP
Phone: 402-991-8999