1134270416 NPI number — ADVANCED FOOT & ANKLE PC

Table of content: (NPI 1134270416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134270416 NPI number — ADVANCED FOOT & ANKLE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED FOOT & ANKLE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134270416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3213 S 24TH ST
Provider Second Line Business Mailing Address:
SUITE 101B
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68108-1832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-345-6503
Provider Business Mailing Address Fax Number:
402-345-0309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3213 S 24TH ST
Provider Second Line Business Practice Location Address:
SUITE 101B
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68108-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-345-6503
Provider Business Practice Location Address Fax Number:
402-345-0309
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CORNELL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
402-345-6503

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  NE164 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0511113 . This is a "IOWA MEDICAID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 349957400 . This is a "U S DEPARTMENT OF LABOR" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 87404 . This is a "COVENTRY HEALTHCARE NEBRA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1049740001 . This is a "DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480018212 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 27-00158 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: CU0388 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02584 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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