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General NPI Number Information
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NPI Number | 1114343449
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Entity Type | Organization
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Legal Business Name | NEBRASKA LOWER EXTREMITY SURGERY GROUP, LLC
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 1301 N 72ND ST
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City | OMAHA
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State | NE
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Zip | 68114-1903
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Country | US
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Telephone | 402-991-8999
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Fax | 402-331-6537
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Provider Business Mailing Address
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Address Line | 2705 SAMSON WAY
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City | BELLEVUE
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State | NE
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Zip | 68123-4307
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Country | US
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Telephone | 402-991-8999
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Fax | 402-331-6537
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Authorized Official
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Title or Position | OWNER
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Name | CHAD A SUMMY
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Credential | DMP
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Telephone | 402-991-8999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 289
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License Number State | NE
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