MEDICARE: FIRST RESPONSE MEDICAL TRAINING

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1619348232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST RESPONSE MEDICAL TRAINING

Provider Business Mailing Address
First Line	:	2904 TRIMMIER RD
Second Line	:	SUITE 2
City	:	KILLEEN
State	:	TX
Zip	:	76542-6038
Country	:	US
Telephone Number	:	254-247-0460
Fax Number	:	254-245-8899

Provider Business Practice Location Address
First Line	:	2904 TRIMMIER RD
Second Line	:	SUITE 2
City	:	KILLEEN
State	:	TX
Zip	:	76542-6038
Country	:	US
Telephone Number	:	254-247-0460
Fax Number	:	254-245-8899

Authorized Official
Title or Position	:	PA
Name	:	MR. MICHAEL ANDERSON
Credential	:	PA-C
Telephone Number	:	254-247-0460

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	10/08/2015

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