Healthcare Provider Details

I. General information

NPI: 1831176486
Provider Name (Legal Business Name): JASON G HASS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 11TH ST
SUPERIOR NE
68978-1101
US

IV. Provider business mailing address

PO BOX 407
SUPERIOR NE
68978-0407
US

V. Phone/Fax

Practice location:
  • Phone: 402-879-4781
  • Fax: 402-879-3365
Mailing address:
  • Phone: 402-879-4781
  • Fax: 402-879-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0676
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: