Provider Demographics
NPI:1285499715
Name:STATE OF NEBRASKA DEPARTMENT OF ADMINISTRATIVE SERVICES
Entity type:Organization
Organization Name:STATE OF NEBRASKA DEPARTMENT OF ADMINISTRATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:KASSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-479-5636
Mailing Address - Street 1:801 W PROSPECTOR PL BLDG 1
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-1970
Mailing Address - Country:US
Mailing Address - Phone:402-479-5636
Mailing Address - Fax:
Practice Address - Street 1:801 W PROSPECTOR PL BLDG 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1970
Practice Address - Country:US
Practice Address - Phone:402-479-5636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEBRASKA DEPARTMENT OF ADMINISTRATIVE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health