Basic Information
| Provider Information | |||||||||
| NPI: | 1053316927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 988102 NEBRASKA MEDICAL CTR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681988102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025596637 | ||||||||
| FaxNumber: | 4025598333 | ||||||||
| Practice Location | |||||||||
| Address1: | 987400 NEBRASKA MEDICAL CTR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025596637 | ||||||||
| FaxNumber: | 4025598333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 06/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0005X | 20107 | NE | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine | 207P00000X | 20107 | NE | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0957148 | 05 | OH | MEDICAID | P00212587 | 01 | OH | MEDICARE RR | OTHER | P00273469 | 01 | OH | MEDICARE RR | OTHER | 000000360688 | 01 | OH | ANTHEM BCBS | OTHER | 000000377192 | 01 | OH | ANTHEM BCBS | OTHER |