Provider Demographics
NPI:1558425710
Name:ANDREASSEN, ROSS DIMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:DIMIL
Last Name:ANDREASSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 INDEPENDENCE SQ
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4239
Mailing Address - Country:US
Mailing Address - Phone:417-256-1761
Mailing Address - Fax:417-256-1763
Practice Address - Street 1:3000 INDEPENDENCE SQ
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4239
Practice Address - Country:US
Practice Address - Phone:417-256-1761
Practice Address - Fax:417-256-1763
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000174760207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00892882OtherMEDICARE RR
MO658905OtherHEALTHLINK
MO1558425710Medicaid
MOH33029Medicare UPIN
MO137740017Medicare PIN
MOMA2027010Medicare PIN
MO1558425710Medicaid