Provider Demographics
NPI:1730181751
Name:CAPITAL FOOT & ANKLE, P.C.
Entity type:Organization
Organization Name:CAPITAL FOOT & ANKLE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TENNITY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-483-4485
Mailing Address - Street 1:1150 N 83RD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2094
Mailing Address - Country:US
Mailing Address - Phone:402-483-4485
Mailing Address - Fax:402-483-5372
Practice Address - Street 1:1150 N 83RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2094
Practice Address - Country:US
Practice Address - Phone:402-483-4485
Practice Address - Fax:402-483-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========OtherTAX ID #
NE=========07Medicaid
NE=========OtherTAX ID #
NE099021Medicare PIN