Provider Demographics
NPI:1154371045
Name:COASH, RUSSELL E (PA-C)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:E
Last Name:COASH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361-0268
Mailing Address - Country:US
Mailing Address - Phone:402-759-4485
Mailing Address - Fax:402-759-4487
Practice Address - Street 1:1840 F ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361-2211
Practice Address - Country:US
Practice Address - Phone:402-759-4485
Practice Address - Fax:402-759-4487
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1104363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE207Q00000XMedicaid
NE099608001Medicare PIN
Q08426Medicare UPIN