Basic Information
| Provider Information | |||||||||
| NPI: | 1114986007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANEDY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 S 144TH ST STE 212 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681445253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026370800 | ||||||||
| FaxNumber: | 4026370808 | ||||||||
| Practice Location | |||||||||
| Address1: | 2725 S 144TH ST STE 212 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681445253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026370800 | ||||||||
| FaxNumber: | 4026370808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 12/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 28115 | IA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 17692 | NE | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0900093 | 01 | NE | AMERICHOICE-2725 S. 144 | OTHER | 202121291 | 01 | NE | RAILROAD MEDICARE | OTHER | 200046163 | 01 | IA | RAILROAD MEDICARE | OTHER | 0929109 | 05 | IA | MEDICAID | 6929109 | 05 | IA | MEDICAID |