MEDICARE: DR. JOHN T FERRELL M.D.,F.A.C.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	04-30693	KS
2	207RC0000X	Cardiovascular Disease Physician	04-30693	KS
3	207RI0011X	Interventional Cardiology Physician	04-30693	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04-30693	OTHER	KS	KANSAS LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174529184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN T FERRELL M.D.,F.A.C.C.

Provider Business Mailing Address
First Line	:	311 E SPRUCE ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846
Country	:	US
Telephone Number	:	620-275-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E SPRUCE ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846
Country	:	US
Telephone Number	:	620-272-2431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	12/01/2010

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