Provider Demographics
NPI:1871787234
Name:FREDERICK A. MAUSOLF, M.D., P.C.
Entity type:Organization
Organization Name:FREDERICK A. MAUSOLF, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAUSOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-486-4269
Mailing Address - Street 1:4645 NORMAL BLVD STE 245
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5823
Mailing Address - Country:US
Mailing Address - Phone:402-486-4269
Mailing Address - Fax:402-486-1038
Practice Address - Street 1:4645 NORMAL BLVD STE 245
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5823
Practice Address - Country:US
Practice Address - Phone:402-486-4269
Practice Address - Fax:402-486-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14776332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
B67749Medicare UPIN