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General NPI Number Information
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NPI Number | 1154371045
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Entity Type | Individual
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Provider Name | RUSSELL E COASH PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 1840 F ST
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City | GENEVA
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State | NE
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Zip | 68361-2211
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Country | US
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Telephone | 402-759-4485
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Fax | 402-759-4487
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Provider Business Mailing Address
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Address Line | PO BOX 268
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City | GENEVA
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State | NE
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Zip | 68361-0268
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Country | US
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Telephone | 402-759-4485
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Fax | 402-759-4487
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1104
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License Number State | NE
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