Provider Demographics
NPI:1679657423
Name:SCOTT J. FASSE, M.D., P.C.
Entity Type:Organization
Organization Name:SCOTT J. FASSE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FASSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-884-7218
Mailing Address - Street 1:614 N 108TH CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1762
Mailing Address - Country:US
Mailing Address - Phone:402-884-7218
Mailing Address - Fax:402-884-7589
Practice Address - Street 1:614 N 108TH CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1762
Practice Address - Country:US
Practice Address - Phone:402-884-7218
Practice Address - Fax:402-884-7589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099483Medicare ID - Type Unspecified