Basic Information
| Provider Information | |||||||||
| NPI: | 1932427069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATHIASEN | ||||||||
| FirstName: | ROSS | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 981150 NEBRASKA MEDICAL CTR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681981150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025596637 | ||||||||
| FaxNumber: | 4025599659 | ||||||||
| Practice Location | |||||||||
| Address1: | 981150 NEBRASKA MEDICAL CTR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681981150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025596637 | ||||||||
| FaxNumber: | 4025599659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2010 | ||||||||
| LastUpdateDate: | 09/04/2015 | ||||||||
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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 | 207P00000X | R-8823 | IA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 40647 | IA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PS0010X | 28791 | NE | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Sports Medicine |
No ID Information.